Invasive papillomatosis and squamous carcinoma complicating juvenile laryngeal papillomatosis

Juvenile laryngeal papillomatosis (JLP), usually a benign, self-limited disease, occasionally has a highly aggressive course characterized by extension of neoplastic cells into the tracheobronchial tree, lung, and soft tissues. Less frequently, squamous carcinoma has arisen in JLP, most commonly following radiation therapy. Rarely, carcinoma has occurred without previous irradiation, but distant metastases do not generally occur. We describe a 14-year-old boy, with a particularly aggressive form of JLP, who developed invasion of the lungs, intrapulmonary lymph nodes, and arteries by cytologically benign neoplastic tissue. He also developed a metastasizing squamous carcinoma of the lung and humoral hypercalcemia of malignancy. A discussion of the implications of the case and a review of the current literature are provided.