TY - JOUR T1 - Verrucous carcinoma of the tracheobronchial tree: an underdiagnosed entity? JF - European Respiratory Journal JO - Eur Respir J SP - 1198 LP - 1200 DO - 10.1183/09031936.00129913 VL - 43 IS - 4 AU - Claus Steppert AU - Joseph Alhanna AU - Juergen Schubert AU - Jens Krugmann AU - Michael Vieth Y1 - 2014/04/01 UR - http://erj.ersjournals.com/content/43/4/1198.abstract N2 - 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 … ER -