Pulmonary Papilloma: A Comprehensive Review

Background: Pulmonary papillomas are rare benign papillary neoplasms of the respiratory tract, characterized by fibrovascular cores lined by epithelial cells. Despite their benign nature, they pose diagnostic challenges due to overlapping features with malignant lesions. Aim: This review aims to provide a comprehensive synthesis of the etiology, epidemiology, pathophysiology, histopathology, clinical presentation, diagnostic strategies, and management of pulmonary papillomas. Methods: A structured literature review was conducted, integrating data from epidemiological studies, histopathological analyses, and clinical reports to outline the spectrum of pulmonary papillomatous disease. Results: Pulmonary papillomas encompass solitary papillomas, inflammatory polyps, and recurrent respiratory papillomatosis (RRP). HPV infection, particularly subtypes 6 and 11, is the predominant etiologic factor, while high-risk genotypes (16, 18) correlate with malignant transformation. RRP incidence is approximately 4 per 100,000 children and 2 per 100,000 adults, with pulmonary involvement in 8–9% of cases. Clinical presentation is often nonspecific, ranging from asymptomatic to obstructive symptoms and hemoptysis. Diagnosis relies on imaging, bronchoscopy, and histopathology. Management includes surgical excision, endoscopic removal, and emerging systemic therapies such as anti-VEGF and PD-1 inhibitors. Prognosis is favorable for solitary lesions but guarded in extensive RRP due to recurrence and rare malignant evolution. Conclusion: Pulmonary papillomas, though uncommon, require multidisciplinary evaluation and vigilant follow-up to prevent misdiagnosis and manage recurrence. Advances in targeted and immunologic therapies offer promising adjuncts to conventional surgical approaches.