Recurrent Respiratory Papillomatosis Surgery Workup: Laborator... https://emedicine.medscape.

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Recurrent Respiratory
Papillomatosis
Surgery Workup
Updated: Oct 13, 2016
Author: John E McClay, MD; Chief Editor: Arlen D Meyers, MD, MBA more...

WORKUP

Laboratory Studies
Laboratory studies for recurrent respiratory papillomatosis (RRP) do not exist, although
biopsies of the papillomas themselves can be tested to determine the type of human
papillomavirus (HPV) present. Some reports indicate that human papillomavirus (HPV) type
11 may be more aggressive than human papillomavirus (HPV) type 6; however, that is
debatable.

Currently, no clinical reason exists to type human papillomavirus (HPV). Routinely or

occasionally, however, obtaining a biopsy of the papilloma evaluated is important to detect
squamous metaplasia or progression to carcinoma.

Imaging Studies
If any papilloma is diagnosed on flexible fiberoptic nasopharyngoscopy, no imaging studies
are necessary for initial diagnosis.

For children with airway obstructive symptoms for which no lesion is observed in the glottic
larynx, certain imaging studies can be obtained for diagnosis of airway obstructive lesions of
the trachea.

Fluoroscopy with barium swallow can be used to diagnose gastroesophageal reflux disease
(GERD) and vascular abnormalities that compromise the trachea or esophagus. This test
may also help diagnose dynamic or static tracheal stenosis.

Bronchoscopy is the single best diagnostic tool to initially evaluate a child in respiratory
distress who has no lesion in the larynx.

CT scanning and MRI are not good initial imaging evaluators for a child with airway distress.
For children with distal spread of papillomas into the trachea and bronchus, a CT scan of the
chest is an appropriate method to evaluate for pulmonary disease.

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Recurrent Respiratory Papillomatosis Surgery Workup: Laborator... https://emedicine.medscape.com/article/865758-workup

Diagnostic Procedures
The diagnostic procedure of choice for recurrent respiratory papillomatosis (RRP) is initial
flexible laryngoscopy in the clinic. If this is not diagnostic, the secondary diagnostic
procedure of choice is a rigid bronchoscopy in the operating room with biopsy of the lesion.

Histologic Findings
The histologic appearance of laryngeal papillomas is characterized by papillary fronds of
multilayered benign squamous epithelium that contain fibrovascular cores. No surface
keratinization is observed. Koilocytes (vacuolated cells with clear cytoplasmic inclusions that
signal presence of viral infection) are observed.

Biopsies for histologic evaluation taken during surgical excision should occur frequently
enough to detect squamous metaplasia, dysplasia, or conversion to squamous cell
carcinoma (SCC). The exact timing of biopsy intervals is not well documented. Surgical
patterns of biopsy range from taking a biopsy during every surgical procedure to never
taking a biopsy because the diagnosis is already known.

Staging
A uniform staging system for laryngeal or tracheal papilloma does not exist. Both Kashima
and Wiatrak have proposed staging systems to quantify disease for comparison of
treatments. [11] Many studies evaluating medical therapy have their own internal scale or
staging system.

Treatment & Management

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