C67-21 Recurrent Adult Tracheal Squamous Papilloma Secondary to Childhood HPV Exposure: An Unusual Cause of Dyspnea

Abstract Introduction Recurrent respiratory papillomatosis (RRP) is a rare benigncondition caused by human papilloma virus (HPV) infection, typically subtypes 6and 11. Although more commonly seen in the larynx and presenting duringchildhood, adult presentations involving the trachea are uncommon and can posesignificant diagnostic challenges when symptoms are nonspecific. We present acase of tracheal squamous papilloma manifesting as unexplained dyspnea in anadult patient with remote childhood airway surgery. Case Presentation 34-year-old man with no significant past medical history presentedto pulmonary clinic with progressive shortness of breath. Pulmonary functiontesting demonstrated a restrictive pattern, prompting a high-resolutionchestCT, which unexpectedly revealed a large soft-tissue mass within the proximaltrachea. The patient denied any prior pulmonary disease but, upon detailedquestioning, recalled undergoing multiple airway procedures as a child to“remove something from his windpipe”, which were discontinued afterage18. Flexible bronchoscopy revealed a large, exophytic soft-tissue masspartially obstructing the tracheal lumen. Multiple biopsies were obtained usingforceps and cryotherapy techniques. Pathology demonstrated squamous papilloma,and testing for high-risk HPV was positive. Review of old surgical recordsconfirmed the previous diagnosis of tracheal squamous papillomatosis duringchildhood. The case was discussed at a multidisciplinary tumor board, where theconsensus was to proceed with bronchoscopic removal using photodynamic therapyto achieve airway patency and minimize recurrence risk. Discussion Tracheal involvement in RRP is rare andoften underrecognized, as symptoms such as dyspnea or cough can mimic otherpulmonary or airway disorders. This case highlights how remote childhoodHPVexposure may result in recurrent adult tracheal papillomatosis decades later. The benign nature of squamous papilloma belies its potential for airwayobstruction, recurrent growth, and rarely, malignant transformation. Accuratediagnosis requires a high index of suspicion, particularly in adults withunexplained airway obstruction and a history of childhood airway procedures.Early detection through bronchoscopy and appropriate multidisciplinarymanagement—including surgical removal and adjunctive therapies such asphotodynamic or antiviral treatment—can optimize outcomes and preventrecurrence. This abstract is funded by: N/A