Laryngeal papillomatosis (squamous papilloma)

Laryngeal papillomatosis, also known as squamous papilloma is the most common benign laryngeal neoplasm.  The lesion can be single or multiple and typically occurs along the true and false vocal cords.  Nonetheless, it can occur anywhere along the larynx.  The lesion shows papillary, exophytic growth with fibrovascular core (left).  Multilayered squamous epithelium is shown without keratinization (right).

Two clinical forms of squamous papilloma exist: 1) juvenile and 2) adult. Multiple lesions occur in the juvenile form with frequent and rapid recurrence after treatment. In contrast, the adult form lesions are frequently single. Both are thought to be secondary to HPV infection. Recurrence of the tumor is common, especially the juvenile type. Moreover, transformation to malignant form has been reported in about 20% of adult cases. Patients typically present with stridor, dyspnea, cough, and/or dysphonia. A variety of treatment options are available, and include: laser surgery, surgical excision, cryosurgery, and electrocautery. The goal of the therapy is the removal of the tumor with minimal compromise of the trachea and larynx. Radiation therapy is contraindicated as it increases the risk of malignant transformation (i.e., especially in juvenile type).