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Tracheobronchial papillomatosis

Trecheobronchial papillomatosis refers to the occurrence of multiple squamous cell papillomas involving trachea and bronchi. It is the most common benign tumour in laryngo-tracheal region.

Multiple papillomas can occur at other sites which have distinctive terms. Examples include:

This article covers the laryngo-tracheo-bronchial type.

Epidemiology

There is a recognised bi-modal age distribution. The juvenile type is typically (and not surprisingly) seen in children.

In adults there is an association with smoking.

Pathology

They consist of squamous cell papillomata (which are abnormal proliferations of squamous epithelium) ,which are thought to occur due to infection of the mucosa with HPV 6 and 11 (possibly also 16 and18). Lesions often tend to be limited to the nasopharynx but can descend to involve the tracheobronchial tree in 1-5% of cases. Isolated tracheobronchial involvement is seen more frequently in adults. Lesions may be sessile, papillary, lobulated, or polypoid.

Radiographic features

Plain film

Chest x-rays are often normal, especially if lesions are limited to the larynx. If more extensive small lesions can be appreciated which may appear solid of cavitatory 7.

When papillomas result in airway obstruction then atelectasisbronchiectasis and mucus plugging (finger in glove appearance) may be seen.

CT

Typically CT demonstrates thin walled cysts with adjacent nodules. These are 2-3 mm in size 7.

With more widespread disease there may be a dorsal (posterior) predilection due to gravity.

CT is also able to demonstrate distal  atelectasisbronchiectasis and mucus plugging.

Treatment and prognosis

Although tracheobronchial papillomas tends to be slow growing treatment is usually ineffective with high recurrence rate (~ 90%). With disease progression and dissemination comes gradual respiratory failure and an overal poor prognosis. Bronchoscopic excision with or without laser therapy has been traditionally performed with disappointing results.

There is a small risk of malignant degeneration into squamous cell carcinoma of the treacheo bronchial tree..

Differential diagnosis

General imaging differential considerations include

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