Zusammenfassung
Hintergrund: Die juvenile Larynxpapillomatose ist die häufigste gutartige Tumorerkrankung des Larynx bei Kindern und Jugendlichen. Häufig weist diese Erkrankung einen protrahierten rezidivierenden Krankheitsverlauf auf, z. T. auch mit Fortschreiten der Papillomatose in das Tracheobronchialsystem. Vereinzelt wurde über eine Entstehung von Plattenepithelkarzinomen im Rahmen eines Larynxpapilloms bei Erwachsenen, nach Bestrahlung oder Vorliegen von Noxen (z. B. Nikotin) berichtet. Es gibt aber nur vereinzelte Literaturberichte von malignen Entartungen im Rahmen einer juvenilen Larynxpapillomatose ohne Vorliegen von Risikofaktoren.
Fallbericht: Wir berichten über einen 11-jährigen Jungen, der an einer rezidivierenden juvenilen Larynxpapillomatose erkrankt war. Die mehrmaligen laserchirurgischen Abtragungen sowie eine Therapie mit Interferon zeigten nur eine kurzfristige Remission der Erkrankung. Eine Tracheotomie aufgrund einer Stenosierung des Larynx war unvermeidbar. 7 Monate nach Erstdiagnose der rezidivierenden juvenilen Larynxpapillomatose wurde ein ausgedehntes und regional metastasiertes Plattenepithelkarzinom des Larynx festgestellt, an dem der Junge trotz kombinierter Radiochemotherapie 11 Monate später verstarb.
Schlussfolgerungen: Die spontane Transformation und Entartung der juvenilen Larynxpapillomatose in ein Plattenepithelkarzinom ist extrem selten. Die hohe Malignität führte sowohl zur frustranen chirurgischen als auch konservativen Therapie (Interferon und Radiochemotherapie). Aufgrund des kurzen zeitlichen Intervalls zwischen Erstdiagnose der Papillome und der malignen Entartung muss sowohl an eine besonders aggressive Verlaufsform der Papillomatose als auch an zwei voneinander unabhängige Krankheiten gedacht werden.
Abstract
Background: The juvenile laryngeal papilloma is the most common benign neoplasm in children. Often the entity shows an elongated recurrent course of disease with an expansion into the tracheo-bronchial system. Sporadic malignant transformation in adults with a papilloma was reported after treatment with radiotherapy alone or in combination with the intake of additional toxins (e. g. nicotine). Similar reports of a malignant transformation of juvenile papillomas without additional risk factors is very rarely reported.
Case report: We report about an 11 year old boy, who suffered from a juvenile laryngeal papilloma. The multiple laser surgical procedures and a therapy with interferon resulted in a short-term remissions. A tracheotomy was inevitable. Seven months after the first diagnosis of the papilloma a regional metastatic squamous cell carcinoma was found. In spite of combined radiotherapy and chemotherapy the boy died 11 months later.
Conclusions: The spontaneous malignant transformation of a juvenile papilloma in a squamous cell carcinoma is extremely rare. The surgical intervention as well the radiotherapy and chemotherapy using interferon was unsuccessful due to the high grade of malignancy. In view of the very short time interval between first diagnosis of juvenile papilloma and the subsequent malignant transformation, one must consider either the potential presence of a very aggressive form of papilloma or alternative two coincident independent diseases.
Schlüsselwörter
Larynxpapillomatose - Entartung - Therapieoptionen
Key words
Juvenile laryngeal papilloma - malignant transformation - therapy
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PD Dr. med. Anke Lesinski-Schiedat
Medizinische Hochschule Hannover, Klinik für Hals-, Nasen-, Ohrenheilkunde
Carl-Neuberg-Straße 1 · 30625 Hannover
Email: les@hoerzentrum-hannover.de