MALIGNANT TRANSFORMATION OF A JUVENILE LA RYNGEAL PAPILLOMATOSIS

Background: Spontaneous malignant transformation of laryngeal papillom atosis was in the past mostly negated, or the discussion in literature was rather toned down and reserved. Therefore, from a biological and prognostic point of view, HPV infection of the larynx seems to carry a different weight than a viral infection in genital region. According to general consensus, secondary, malignant transformation in juvenile papillomatosis occurs in irradiated patients and leads to the conclusi on that radiation therapy of this disease is presently contraindicated . Because there is as yet no causal and curative treatment, repeated a nd frequent removal of papillomatous tissue by microlaryngoscopy may o ften be necessary to keep the airway patent. Patient, Method and Resul ts: We diagnosed and treated an advanced laryngeal squamous cell carci noma with lymphatic metastasis in a 50-year old male. Juvenile papillo matosis had been diagnosed already at the age of five, and at the pati ent's last presentation 5 years ago (age 45), typical clinical and his tological features of laryngeal papillomatosis had been observed. Furt hermore, virus infection of the papillomatous tissue (HPV-6/11) was pr oved by using the technique of insitu hybridisation. Risk factors for malignant transformation, such as smoking, alcohol or radiation, were denied by the patient. Conclusions: From these aspects, a spontaneous, malignant transformation of laryngeal papillomatosis must be consider ed with regard to six similar observations in the German and English l iterature. In the reported case, a tumoural origin in the flat larynge al mucosa in close neighbourhood to the former site of papillomas, is less probable, albeit not ruled out completely, since continuous chang es from benign squamous papilloma to atypical, invasive tumour and a H PV-infection in the carcinomatous tissue could not be proved by in-sit u hybridisation.