Suppression of respiratory papillomatosis with malignant transformation by erlotinib in a kidney transplant recipient

Abstract

A 52-year-old non-smoker and renal transplant recipient developed an incessant cough. A CT scan of the thorax revealed ill-defined hazy opacities in the right upper lung. He was diagnosed with non-tuberculosis Mycobacterium chelonae/abscessus infection based on sputum culture results. A trial of antibiotics initially resulted in some clinical improvement. A subsequent CT of the thorax documented worsening of the lesions in the right lung and new lesions on the left. An intratracheal growth was noted. Bronchoscopy with biopsy of the tracheal lesions documented respiratory papillomatosis with transformation to squamous cell cancer. Test for high-risk human papilloma virus was positive. Video-assisted thoracoscopic surgery biopsy with wedge resection of the left lower lobe revealed metastatic squamous cell lung cancer. He was treated with one ablation followed by four cycles of chemotherapy. He has been maintained on erlotinib ever since. There has been no recurrence of the cough or papillomas.

Figure 1

Bronchoscopic micrographs (A, B, C, H and I), CT (D and E), positron emission tomography (F and G) images showing polypoid growth in trachea near carina and lung cancer before (D, F, H and I,) and after (A–C, E and G) chemotherapy and erlotinib maintenance.

Figure 2

H&E staining under low (A) and high (B) magnification showing papilloma and squamous cell histology with atypia, respectively. The specimen stained positive for P16 (C), human papilloma virus 16 (HPV16) DNA (in situ, D). The left lower lobe wedge biopsy was positive for invasive squamous cell carcinoma (E) and also stained positive for P16 (F).