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Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The human papillomavirus (HPV) is the causative agent of genital warts, is related to a variety of skin diseases in humans, and plays a role in the tumorigenesis of a variety of malignant tumors of the head, neck, anus, and lower genital tract. The discovery of its predominant role in the development of cervical cancer has allowed the development of a variety of screening and prevention protocols. To date, more than 100 HPV types have been identified. The prevalence of HPV in pregnancy has been reported anywhere from 6% to 70% (5) with the highest prevalence in women under the age of 26. It has also been suggested that the pregnant state may activate HPV expression, the mechanism of which is unclear, but likely involves a change in the immune status of the mother. HPV is of concern during pregnancy for several reasons. First, although it remains unclear the frequency of perinatal transmission, consensus holds that neonates can be exposed to maternal cervical HPV during pregnancy and birth. Studies have shown HPV to be causally related to recurrent laryngeal papillomatosis in children (6,7). Maternal history of genital warts in pregnancy has been shown to be the strongest predictive factor for respiratory papillomatosis in the child (8). A second concern is that the papillary lesions can proliferate and cause soft-tissue dystocia or potential hemorrhage upon attempted vaginal delivery.
Larynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
More common in the paediatric population than adults, laryngeal papillomatosis is frequently due to exposure to human papillomavirus (HPV) types 11 and 6. In paediatric patients, this exposure may occur during passage through the birth canal, as both HPV subtypes are known to be associated with genital warts.
Cidofovir and Brincidofovir
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Graciela Andrei, Robert Snoeck
Laryngeal papillomatosis is another clinical presentation of HPV-induced lesions characterized by a high relapse rate and necessitating frequent intervention, sometimes in very young children. The potential of CDV to treat such lesions has been demonstrated in a report including a case series of 17 patients with severe recurrent laryngeal papillomatosis (Snoeck et al., 1998). CDV at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions. Complete disappearance of the papillomatosis was observed in 14 patients; 4 patients who relapsed were successfully treated again with CDV. Of the 3 remaining patients, one progressed while under treatment with CDV after an initial marked response; another patient with a very aggressive and extensive disease originally had a partial remission and remained stable for more than 1 year after the last injection; and the final patient was lost to followup after four injections. The mean duration of treatment for patients who remained disease free after treatment was 3.3 months (range: 1–8 months), with a mean duration of complete remission of 13.6 months (range: 2–27 months). Treatment was well tolerated, and no significant side effects were noted. It was concluded that intratumoral injections of CDV for the treatment of severe laryngeal papillomatosis was a powerful new therapeutic approach for this disease. These initial observations were confirmed in other studies, both for adults and children, and intralesional CDV appeared to be especially promising when combined with surgery (Goon et al., 2008; Naiman et al., 2003; Pontes et al., 2006; Pudszuhn et al., 2007; Shi et al., 2008; Snoeck, 2006; Soma and Albert, 2008).
Tracheotomy as a predictor of remission and demise for juvenile-onset recurrent respiratory papillomatosis
Published in Acta Oto-Laryngologica, 2022
Zijie Niu, Yang Xiao, Lijing Ma, Xiaoli Qu, Yuge Wang, Sihan Zhou, Jun Wang
Furthermore, this is the first study to explore the impact of tracheotomy in the relapse interval after controlling for the age at diagnosis. In this study, the surgical intervals in tracheotomized patients were analyzed separately before and after the tracheotomy and compared to non-tracheotomized patients. The surgical interval after tracheotomy in JORRP patients was longer than that before tracheotomy, but it was shorter than that in patients without tracheotomy. Therefore, the tracheotomy can’t alleviate the frequent operations in patients with laryngeal papillomatosis, but facilitate the probability of aggressiveness, diverging from the findings described by Guo et al. [2] and Lawlor et al. [20]. Every effort should be made to avoid tracheotomy, and when it is unavoidable, the tracheal cannula should be removed as soon as possible.
Risk factors for aggressive recurrent respiratory papillomatosis in Chinese juvenile patients
Published in Acta Oto-Laryngologica, 2020
Yue Xi, Hua Wang, Wei Wang, Xiaolin Wang, Jie Zhang, Jing Zhao, Guixiang Wang, Jingang Gui, Xin Ni
The demographic and clinical characteristics of JORRP patients are described in Table 1. Overall, 46 JORRP patients from Beijing Children’s Hospital who underwent surgery from January 2018 to December 2019 were enrolled. Patients were selected through hospital registry systems, and their records were reviewed by two laryngologists. Only patients with histopathologically verified laryngeal papillomatosis were included. Clinical records and socioeconomic status were reviewed. The observation time for each patient was defined as the time from the first surgery to the last admission to the hospital. Patients with insufficient observation time < 1 year were excluded.
Correlation Between E6 and E7 Oncogenes and Malignant Transformation of Laryngeal Papillomatosis (LP) with Human Papillomavirus (HPV) in Pediatric Population
Published in Fetal and Pediatric Pathology, 2021
Zaid Khreefa, Vivian Isaac, Janet Poulik, Richard Felix, Wasim Selwanes, Ruchi Mangal, Pheven Dereje, Khairya A. Fatouh, Bahig M. Shehata
Laryngeal papillomatosis (LP), the most common benign neoplasm affecting the upper respiratory tract mucosa in children, is induced by human papillomavirus (HPV) infection usually before 5 years of age [1]. This early onset presentation is classified as juvenile laryngeal papillomatosis (JLP). Another form of laryngeal papillomatosis occurs in the adult population between the ages of 20–40 and is classified as adult laryngeal papillomatosis (ALP) [2].