Larynx, hypopharynx & trachea
Benign tumors / nonneoplastic
Papilloma / papillomatosis


Topic Completed: 1 January 2015

Minor changes: 21 November 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Papilloma [title] larynx [title]

Nat Pernick, M.D.
Adriana Handra-Luca, M.D.
Page views in 2019: 6,735
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Cite this page: Pernick N, Handra-Luca A. Papilloma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/larynxpapilloma.html. Accessed May 26th, 2020.
Definition / general
  • Warty outgrowths of laryngeal surface epithelium
Clinical features
  • Children:
    • Usually multiple
    • Occur on true vocal cords, false cords, epiglottis, subglottic area and rarely tracheobronchial tree
    • Recurs commonly, possibly years after excision or destruction; recurrences often cease at puberty; recurrences may be massive and rapid leading to airway compromise and tracheostomy or laryngectomy
    • Associated with HPV 6 and 11 in most cases
    • Rarely extends into tracheostomy stoma or laryngeal soft tissue (invasive papillomatosis), rarely develops squamous cell carcinoma after radiation therapy or spreads / progresses to lower respiratory tract as papilloma or squamous cell carcinoma

  • Trachea:
    • Benign squamous lesion similar to laryngeal lesions, due to infection with HPV6, HPV11 (Chron Respir Dis 2011;8:233, J Med Virol 2004;72:473)
    • Juvenile and adult onset
    • Symptoms: cough, hemophtysis
    • May disappear spontaneously
    • May occur in patient with primary biliary cirrhosis, Cowden disease, tuberculosis
    • Cases associated with laryngeal lesions have low incidence of malignant transformation
    • Cases limited to trachea and bronchi usually begin in adults, have higher incidence of malignant transformation
    • Tracheotomy is associated with progression of laryngeal papilloma into trachea (Zhonghua Er Bi Yan Hou Ke Za Zhi 2000;35:384)
Case reports
Treatment
  • Excision, electrodesiccation, laser surgery or cryosurgery
  • Treatment may destroy vocal cords; laryngectomy if extensive involvement
  • Trachea: HPV vaccine (to prevent); medical therapy, multiple surgery if recurrence
Microscopic (histologic) description
  • Proliferative well differentiated squamous epithelium overlying fibrovascular cores with koilocytotic change (enlarged, often multiple, wrinkled nuclei)
  • May have mild to moderate dysplasia (increased cellularity, loss of regularity of basal layer, hyperchromatic nuclei extending from basal to intermediate layers), mitotic activity is common
  • Tumors in respiratory mucosa have less apparent maturation
  • Trachea:
    • Usually benign squamous, intermediate and ciliated cells overlying fibrovascular stroma
    • Invasive tumor may have intracystic papillary structures, atypical invasive epithelium
Microscopic (histologic) images

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Papilloma

Differential diagnosis
  • Oat cell carcinoma: looks similar at bronchoscopy
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