Transplantation in Two Patients With Cystic Fibrosis

DisCussioN Bronchogenic squamous cell carcinoma is a rare cornplication of RRP in the absence of a history of irradiation or smoking. In previous cases, it arose as a complication of RRP that extended into the tracheobronchial tree before diagnosis of the malignancy. In some cases, the malignancy was an incidental finding at autopsy of patients with RRP dying of pneumonia or respiratory failure.5 The unique feature of this case was the development of a bronchogenic squamous cell carcinoma in a patient in whom RRP had remained clinically localized to the larynx for 45 years. Distal involvement would not have been surprising in view of the recognized subglottic involvement, disease duration, previous tracheostomies, and numerous endoscopic excisions.2 Steinberg et al7 demonstrated that HPV is present in normal-appearing mucosa in patients with RRP. Therefore, the development of a bronchogenic carcinoma in apparently uninvolved mucosa is not surprising. This case represents an important caveat. Squamous cell carcinoma of the lung can develop in the absence of obvious RRP extension into the tracheobronchial tree, indicating the importance of considering this possibility in patients with RRP who present with cough or other lower respiratory tract symptoms.