Endoscopic diagnosis of recurrent relapsing papillomatosis
23 April 2019 (online)
The recurrent relapsing papillomatosis (rrp) is a chronic relapsing disease of viral cause, which is characterised by the recurrent growth of multiple papillomas in the aerodigestive tract. The development of new endoscopic techniques has led to an optimization of the depiction of the laryngeal mucosa and its vessels and to a better pre- and intra-operative diagnosis of laryngeal pathologies.
The depiction of papillomas was evaluated using different endoscopic techniques. Those are the endoscopy with white light, the chromoendoscopy after use of local colour solutions (lugol's iodine or indigocarmin), the chromoendoscopy after use of light of specific wavelength (NBI-light, autofluorescence and induced fluorescence) as well as the contactendoscopy.
The features of the papillomas are the irregular surface with multiple papillas, which can be flat or elevated, the multiple lesions and the perpendicular vessels, which are vertical to the mucosal surface and impose as vessel loops. The perpendicular vessels can be also found in mucosal hyperplasia and in precancerous and cancerous lesions and can be demonstrated very well in the NBI endoscopy and in the contactendoscopy. In the papillomas the vessel loops are thin-walled, regular and scarcer, in the carcinomas they are frequent, dilated, irregular and thicker.
By means of different endoscopic techniques it is possible to differentiate papillomas from healthy tissue and recognise a possible malignant transformation. Those techniques can be used intraoperatively and in local anaesthesia. The histological examination can not be replaced but those techniques contribute to an early recognition and treatment.