Tracheal Papilloma Presenting as Refractory Asthma: A Case Report

以頑固型氣喘為表現的氣管內乳突瘤：案例報告

楊景堯(Ching-Yao Yang) ； 王振源(Jann-Yuan Wang)

《胸腔醫學》 28卷2期 (2013/04) Pp. 118-124

摘要

反覆性呼吸道乳突瘤（Recurrent respiratory papillomatosis, RRP）為人類乳突病毒所造成的一種呼吸道良性腫瘤，有反覆發作難以根治的特性。RRP可發生在呼吸道的任何地方，但以喉部為最常見，單獨發生在氣管而無其他部位侵犯者較為稀少。因為臨床症狀如喘及嘨鳴聲等不具特異性，而胸部X光對於氣管內病灶又較不敏感，氣管內乳突瘤往往難以早期診斷而被誤診為氣喘或其他阻塞性呼吸道疾病。此處我們報導一位罹患氣管乳突瘤的25歲男性，起初因咳嗽、喘及嘨鳴聲等徵候被診斷為氣喘，但在支氣管擴張劑及吸入性類固醇的治療下其症狀仍不斷惡化。胸部電腦斷層顯示在氣管內有一花椰菜狀的腫瘤，造成氣管幾乎完全阻塞。由於傳統的氣管插管無法在手術中達到足夠的換氣，此病人在葉克膜體外循環機的支持下順利接受了氣管內的乳突瘤切除。利用原位雜交聚合體鍊狀反應，我們發現在乳突瘤組織裡偵測到一少見的人類乳突病毒基因型（第72型）。由此案例可知，當氣喘對傳統治療反應不佳時，需考慮其他阻塞型呼吸道疾病，氣管腫瘤雖然少見仍須列入考慮。在呼吸道腫瘤的手術中如遇到換氣困難的情況，葉克膜體外循環機為一安全的方式來維持術中適當的通氣使手術得以順利進行。

關鍵字

氣管乳突瘤 ； 反覆性呼吸道乳突瘤 ； 頑固型氣喘 ； 葉克膜體外循環機 ； 人類乳突病毒

並列摘要

Recurrent respiratory papillomatosis (RRP) is a benign neoplasm in the respiratory tract that is recurrent in nature and caused by human papilloma virus (HPV) infection. RRP may arise from anywhere in the respiratory tract, but solitary tracheal papilloma is a relatively rare form of RRP and is frequently misdiagnosed as asthma due to the similar symptoms, including cough, dyspnea, and wheezes. We report a 25-year-old man with tracheal papilloma that was diagnosed as asthma initially. His dyspnea and wheezes were refractory to bronchodilators and inhaled corticosteroids. Chest computed tomography (CT) disclosed a cauliflower-like tumor in the trachea with nearly total obstruction. Surgical resection of the tumor was performed with the support of extracorporeal membrane oxygenation (ECMO), and the pathology report indicated squamous papilloma. HPV type 72 was detected in the tumor tissue by polymerase chain reaction (PCR) followed by a HPV genotype-specific hybridization method. We concluded that a thorough evaluation should be carried out if the asthma is difficult to control. ECMO may be helpful for tracheal tumor resection in patients for whom a conventional anesthesia technique is unsafe.

並列關鍵字

tracheal papilloma ； recurrent respiratory papillomatosis ； refractory asthma ； extracorporeal membrane oxygenation ； human papilloma virus