難治性喉頭乳頭腫7例の検討

Laryngeal papillomatosis is caused by infection with human papillomavirus (HPV) type 6 and/or 11. Laryngeal papillomatosis recurs frequently, and malignant transformation occurs in 1.6%-4% of the cases. Surgery is the treatment of first choice. While adjuvant therapies such as interferon, Chinese medicines, proton pump inhibitors, indole 3 carbinol, cidofovir and vaccines have been tried, none has come to be positioned as the standard of care.We report seven patients with laryngeal papillomatosis who underwent multiple surgeries. All were men. The surgery was performed in combination with two or three of the following: use of an electric scalpel, CO2 laser, YAG laser, sharp resection, and intralesional injection of cidofovir. Intralesional injection of cidofovir after resection was performed in four cases, and remission was achieved in three of these cases. Cidofovir is an unapproved drug in Japan and is not yet approved for use in cases of laryngeal papillomatosis in other countries. However, the outcomes in our cases and other reports suggest that intralesional injection of cidofovir is effective.HPV6 (n=5), HPV11 (n=1) and HPV negative (n=1) detected respectively. Malignant transformation occurred in one case and HPV negative. Moreover, p16 immunohistochemistry was performed in all cases. However, no relation with number of operations and HPV status was found.The life cycle of HPV in laryngeal papillomatosis is largely unknown, and there is no consensus on methods of treatment other than surgery. More research is needed to elucidate the life cycle of HPV and the pathophysiology of laryngeal papillomatosis.
浜松医科大学医学部耳鼻咽喉科・頭頸部外科学教室 峯田周幸教授退任記念論文集～症例から学ぶ～
Festschrift for Professor Hiroyuki Mineta In Hornor of His Retirement as Chairman of Hamamatsu University School of Medicine