Laryngeal papilloma-induced chronic airway obstruction: A case report

Abstract

Laryngeal papilloma is a benign tumor characterized by minimal symptoms; however, in rare cases, it can cause airway obstruction and should be treated with caution. A 65-year-old woman presented to the clinic with a history of dyspnea for the past 20 years. Chest computed tomography revealed the presence of a tracheal diverticulum with an internal septum on the right side of the trachea at the apex of the lung. Upon examination, an otorhinolaryngologist revealed a wart-like tumor at the base of the tongue. However, it was ruled out to be the cause of dyspnea owing to the small size of the tumor. Thereafter, the patient was placed under observation. Brochoscopy was performed to investigate the tracheal diverticulum. Bronchoscopy revealed a pedunculated papilloma entering the glottis because of inhalation in the supine position, indicating a high risk of airway obstruction by the papilloma. The patient underwent papilloma resection. Papillomas must be considered in the differential diagnosis of dyspnea. The risk of airway obstruction should not be underestimated in patients with papilloma with reported history of dyspnea, even in the case of small tumors. The patient had a rare tracheal diverticulum, which further complicated the diagnosis of dyspnea.

Keywords: Asphyxia; Dyspnea; Papilloma; Recurrent respiratory papillomatosis; Tracheal diverticulum.

Fig. 1

Chest Computed Tomography (CT) upon admission Chest CT shows a tracheal diverticulum with internal septum on the right side of the trachea (arrows) (A, B: lung windows). A) Axial images. B) Sagittal images. C) Three-dimensional reconstruction of the trachea shows a diverticulum on the right side of the trachea (arrows).

Fig. 2

Fiberoptic nasopharyngoscope findings on admission A wart-like tumor is observed at the base of the tongue on the left side (arrows).

Fig. 3

Bronchoscopic image showing the papilloma. A) Bronchoscopy showing a pedunculated tumor on the left side of the base of the tongue with its base near the epiglottic vallecula (black arrows). B) Bronchoscopy findings during inhalation. When the patient inhaled, the tumor tip moved toward the glottis (white arrows) and airway obstruction was observed.

Fig. 4

Histological examination of the pharyngeal tumor The section shows the hyperemic pharyngeal mucosa covered by non-disordered, acanthotic, and hyperplastic squamous epithelium with papillary fibrovascular cores (arrowheads). No evidence of malignancy was found. (Hematoxylin and eosin staining, × 50).