Endobronchial Epithelial Papilloma Associated with a Foreign Body: DISCUSSION

Endobronchial Epithelial

Since 1927, when bronchial papilloma was first described, Barzo et al indicated fewer than 100 cases of this tumor have been reported, usually as case reports.

Drennan and Douglass classification of this lesion appears to have gained general acceptance and has been utilized in most of the literature.

These authors divided bronchial papillomas into the following three main groups: (1) multiple, (2) inflammatory, and (3) solitary. We will not discuss multiple papilloma. Spencer et al, with the largest descriptive series, noted that bronchial papillomas, especially when solitary, could be confused with bronchial chronic inflammatory granulation tissue polyps. The inflammatory types “consist of chronically inflamed vascular and edematous granulation tissue covered in whole or in part by normal ciliated respiratory-type epithelium.” They resemble common nasal polyps.

The solitary bronchial papilloma is characteristically a well-differentiated simple squamous papillomatous tumor similar in microscopic appearance to the simple squamous papilloma of the skin. Spencer et al and Ashmore also included tumors in this class covered by a mixture of epithelial types including columnar, cuboidal, undifferenti­ated, multilayered, ciliated, and well-differentiated squa­mous epithelium. Of interest, an association is noted with an underlying benign cystadenoma of the bronchial mucus glands. More importantly, however, Spencer emphasized that recurrent and solitary papillomas in individuals over 40 could ultimately develop carcinomatous change and should be searched carefully for foci of transformation. It is this fact which has made surgical excision the procedure of choice for this lesion. suhagra 100

Barzo et al reported three cases of papilloma associated with a foreign body in his collection of eight tumors. In that study, none of the foreign bodies was incorporated in the tumor. The pathology of these tumors was consistent with that of the solitary papilloma. He indicated two of the three tumors resolved spontaneously and one was removed endo- scopically with no recurrence. Berman et al reported a single case of papilloma associated with a nonincorporated foreign body. In that case, the pathology of the tumor was that of an inflammatory polyp.

In our case, the tumor surrounded the foreign body and the tumor pathology was that of a solitary bronchial papil­loma.

We present this case and brief literature review to emphasize a possible relationship of the solitary papilloma to an inciting foreign body. The foreign body may be incorporated in the tumor or may be situated nearby. Further, this review indicates that when caused by a foreign body, simple removal may obviate thoracotomy and excision, a procedure previously thought mandatory.
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