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. 2024 Feb;76(1):596-603.
doi: 10.1007/s12070-023-04220-3. Epub 2023 Sep 12.

Clinico-pathological Factors in Malignant Transformation of RRP

Smile Kajal  1 , Aanchal Kakkar  2 , Farhat Naz  3 , Pranay Tanwar P  3 , Hena Khandakar  2 , Anurag Gupta  4 , Alok Thakar  1 , Hitesh Verma  1
Affiliations

Clinico-pathological Factors in Malignant Transformation of RRP

Smile Kajal et al. Indian J Otolaryngol Head Neck Surg. 2024 Feb.

Abstract

Various clinico-pathological factors play role in the papilloma proliferation and pathogenesis of Recurrent respiratory papillomatosis (RRP). However, it is not known if they are directly responsible for malignant transformation of these papillomas or not. We did this study to elucidate any such association. The most recent debrided tissue of RRP in 20 patients was evaluated for p16 expression, VEGF estimation (tissue expression and serum levels), and tissue HPV DNA concentration. The final histopathology results were then correlated with these pathological factors and with clinical factors like duration of illness, age of onset of symptoms, extent of disease, etc. Squamous papilloma was seen in 60%, dysplasia in 25%, and squamous cell carcinoma (SCC) in 15% of the patients. Positive immunostaining for p16 (staining in ≥70% of tumor cells) was seen only in one case, which was SCC. There was no statistically significant difference between p16 expression, tissue VEGF expression, serum VEGF levels, and tissue HPV DNA in any of the histological groups. The mean age of disease onset was significantly higher in patients with SCC (p = 0.03). A significantly higher number of patients with dysplasia had tracheobronchial involvement (p = 0.022). We concluded that no single pathological factor is solely responsible for development of malignancy in RRP, whereas clinical factors like tracheobronchial involvement and age of onset may contribute to development of dysplasia or carcinoma.

Keywords: HPV DNA; Recurrent respiratory papillomatosis; VEGF; p16.

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Conflict of interest statement

Conflict of interestThe authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1
Laryngeal papillomas removed using coblation
Fig. 2
Fig. 2
Low magnification (A, B, C; HE, 100x) and high magnification (D, E, F; HE, 200x) of cases of squamous papilloma (A, D) papilloma with dysplasia (B, E) and squamous cell carcinoma (C, F) with corresponding p16 (G, H, I; IHC, 200x) and Ki-67 (J, K; IHC, 200x). Squamous papilloma with VEGF staining in endothelial cells lining blood vessels (L; IHC, 200x)
Fig. 3
Fig. 3
A: Papillomas involving Trachea, B: Involvement up to carina
See this image and copyright information in PMC

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