Recurrent respiratory papillomatosis treated with radical photodynamic therapy

SESSION TITLE: Pathology Under the MicroscopeSESSION TYPE: Case ReportsPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmINTRODUCTION: Recurrent respiratory papillomatosis (RRP) is a chronic disease that results in papilloma lesions with various forms of clinical presentations. These lesions can appear throughout the respiratory tract, often presenting on vocal folds or larynx. It is caused by human papilloma virus types 6 and 11. There is no cure for RRP, and the current standard of care is surgical therapy with goal of complete removal of papillomas and preservation of normal structures. Here we present a case in which a patient with severe recurrent respiratory papillomatosis is treated using radical photodynamic therapy (PDT).CASE PRESENTATION: A 25 year old male with no past medical history presented with shortness of breath and dysphonia as a teenager. He was found to have RRP. As a result of his condition, he had undergone debridement every 3 months to resect papillomas and improve airway obstruction.He had then presented to us for his RRP but now with PDT with curative intent. Bronchoscopy redemonstrated numerous papillomas throughout his throughout his trachea and L mainstem bronchus. PDT was successfully applied to the aforementioned areas. There were no complications with the procedure.He returned several weeks later for follow up bronchoscopy, where he showed improvement of his trachea. His trachea was now relieved of papillomatous obstruction.DISCUSSION: RRP is a condition that causes patients to develop papillomas within their respiratory tract, of which presentation and severity can vary. RRP can have a significant disease burden and many patients undergo numerous procedures to alleviate symptoms.Various modalities have been used to treat this disease, including mechanical debridement, cryo-debridement, as well as CO2 lasers. In this case, a technique called PDT was employed. Patients are infused with a photosensitizing agent that is preferentially taken up by hyperplastic tissues. Patients then return for bronchoscopy, where light is generated by a laser at 630 nm wavelength and applied resulting in the development of cytotoxic agents within affected tissue. Studies have shown that patients with RRP treated with PDT show a significant decrease in rate of papilloma growth with some patients able to remain clear of disease. Patients with persistent disease were also able to go longer between repeat intervention.In our case, we were able to successfully employ this technique for treatment of RPP, with follow up bronchoscopy showing successful treatment and sloughing of diseased tissue. Utilization of PDT in patients with RRP can provide significant benefit as well as alleviate some medical care burden.CONCLUSIONS: RRP can pose significant disease burden and requires frequent mechanical debridement. PDT offers a safe and unique non-contact ablative modality that can decrease disease burden from RRP. PDT offered a curative solution to RRP in our patient.Reference #1: Campisi, P. (2017). The epidemiology of recurrent respiratory papillomatosis. Recurrent Respiratory Papillomatosis, 19–31Reference #2: Derkay, C. S., & Wiatrak, B. (2008). Recurrent respiratory papillomatosis: A Review. The Laryngoscope, 118(7), 1236–1247Reference #3: Lieder, A., Khan, M. K., & Lippert, B. M. (2012). Photodynamic therapy (PDT) for recurrent respiratory papillomatosis. Cochrane Database of Systematic Reviews.DISCLOSURES: No relevant relationships by David ChambersNo relevant relationships by Hajra ChannaNo relevant relationships by Jalal DamaniNo relevant relationships by Joseph Gatuz SESSION TITLE: Pathology Under the Microscope SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm INTRODUCTION: Recurrent respiratory papillomatosis (RRP) is a chronic disease that results in papilloma lesions with various forms of clinical presentations. These lesions can appear throughout the respiratory tract, often presenting on vocal folds or larynx. It is caused by human papilloma virus types 6 and 11. There is no cure for RRP, and the current standard of care is surgical therapy with goal of complete removal of papillomas and preservation of normal structures. Here we present a case in which a patient with severe recurrent respiratory papillomatosis is treated using radical photodynamic therapy (PDT). CASE PRESENTATION: A 25 year old male with no past medical history presented with shortness of breath and dysphonia as a teenager. He was found to have RRP. As a result of his condition, he had undergone debridement every 3 months to resect papillomas and improve airway obstruction. He had then presented to us for his RRP but now with PDT with curative intent. Bronchoscopy redemonstrated numerous papillomas throughout his throughout his trachea and L mainstem bronchus. PDT was successfully applied to the aforementioned areas. There were no complications with the procedure. He returned several weeks later for follow up bronchoscopy, where he showed improvement of his trachea. His trachea was now relieved of papillomatous obstruction. DISCUSSION: RRP is a condition that causes patients to develop papillomas within their respiratory tract, of which presentation and severity can vary. RRP can have a significant disease burden and many patients undergo numerous procedures to alleviate symptoms. Various modalities have been used to treat this disease, including mechanical debridement, cryo-debridement, as well as CO2 lasers. In this case, a technique called PDT was employed. Patients are infused with a photosensitizing agent that is preferentially taken up by hyperplastic tissues. Patients then return for bronchoscopy, where light is generated by a laser at 630 nm wavelength and applied resulting in the development of cytotoxic agents within affected tissue. Studies have shown that patients with RRP treated with PDT show a significant decrease in rate of papilloma growth with some patients able to remain clear of disease. Patients with persistent disease were also able to go longer between repeat intervention. In our case, we were able to successfully employ this technique for treatment of RPP, with follow up bronchoscopy showing successful treatment and sloughing of diseased tissue. Utilization of PDT in patients with RRP can provide significant benefit as well as alleviate some medical care burden. CONCLUSIONS: RRP can pose significant disease burden and requires frequent mechanical debridement. PDT offers a safe and unique non-contact ablative modality that can decrease disease burden from RRP. PDT offered a curative solution to RRP in our patient. Reference #1: Campisi, P. (2017). The epidemiology of recurrent respiratory papillomatosis. Recurrent Respiratory Papillomatosis, 19–31 Reference #2: Derkay, C. S., & Wiatrak, B. (2008). Recurrent respiratory papillomatosis: A Review. The Laryngoscope, 118(7), 1236–1247 Reference #3: Lieder, A., Khan, M. K., & Lippert, B. M. (2012). Photodynamic therapy (PDT) for recurrent respiratory papillomatosis. Cochrane Database of Systematic Reviews. DISCLOSURES: No relevant relationships by David Chambers No relevant relationships by Hajra Channa No relevant relationships by Jalal Damani No relevant relationships by Joseph Gatuz