To the Editor:
Verrucous carcinomas, first described by Ackermann [1] in 1948, are rare, well-differentiated squamous cell carcinomas in the oropharynx [2], larynx [2–4] and oesophagus [5], and seem to be associated with Human papilloma virus (HPV) infections [6]. Macroscopically, they have a warty appearance and may easily be mistaken for papillomas [4]. Surprisingly, although found in the larynx, there are no descriptions of this tumour in the tracheobronchial tree.
A 74-year-old male with a history of chronic obstructive pulmonary disease and former smoking was admitted for increasing shortness of breath. On clinical investigation he had a subfebrile temperature (38.2°C) and dry rales. Chest radiography showed discrete infiltrates in the right lower lobe. Lung function testing revealed an obstructive flow–volume loop with a forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio of 32% and a FEV1 of 1.1 L (37% predicted).
Although anti-obstructive treatment was intensified using inhaled β-adrenergics, steroids and antibiotic treatment (ampicillin/sulbactam), the dyspnoea did not improve. On bronchoscopy, the distal trachea was shown to be infiltrated by a wart-like tumour obstructing ∼70% of the cross sectional area (fig. 1). The tumour was partly removed during rigid bronchoscopy and partly …