title: Natural progression of dysplasia in adult recurrent respiratory papillomatosis.
abstract: OBJECTIVE
  Recurrent respiratory papillomatosis (RRP) is often described as a benign disease. However, the natural progression of dysplasia and transformation to squamous cell carcinoma has not been elucidated for RRP. This study delineates our extensive experience with dysplasia in RRP.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Demographic data and surgical pathology were analyzed for patients diagnosed with RRP at greater than 18 years of age who underwent operative intervention without cidofovir treatment for RRP between 2004 and 2009.
  
  
  RESULTS
  Fifty-four patients were identified. Dysplasia was identified in 27 of 54 patients (50%). Of the 54 patients, 50% had no dysplasia, 26% had mild dysplasia (grade 1), 11% had moderate dysplasia (grade 2), 4% had severe dysplasia (grade 3), 7% had carcinoma in situ, and 2% had squamous cell carcinoma as the highest documented degree of dysplasia. Thirty of 54 patients (55.6%) had 2 or more operative interventions. Nine of the 30 patients (30%) developed a higher dysplastic grade during the course of treatment. Time to progression averaged 16.2 ± 8.7 months for patients with initially benign disease. Of those patients with dysplasia progression, only 1 of 9 (11.1%) developed squamous cell carcinoma. Patients presenting with benign or mild dysplasia typically did not progress beyond mild dysplasia (22 of 24, 91.7%).
  
  
  CONCLUSIONS
  Dysplasia is common in RRP. Progression of dysplasia, especially with an initial dysplastic grading of benign or mild disease, is rare.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8605, USA. joseph.e.hall@vanderbilt.edu
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Hall
authors.forename: Karen
authors.initials: K
authors.lastname: Chen
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Yoo
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Fletcher
authors.forename: Robert H
authors.initials: RH
authors.lastname: Ossoff
authors.forename: C Gaelyn
authors.initials: CG
authors.lastname: Garrett
mesh_terms: D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D030361:Papillomavirus Infections / Q000473:pathology; D011379:Prognosis; D020545:Respiratory Mucosa / Q000473:pathology*; D012141:Respiratory Tract Infections / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index