Histopathological criteria

Significant histological prognosticators of local recurrences and malignant transformation have not been identified {501, 908,2100}.

DNA ploidy, proliferation

DNA aneuploidy and Ki-67 proliferative index, in contrast to histologic indices, have been found to predict disease recurrence and extension for children with RRP {2470,2471}.

HPV genotype

HPV 11 and 16 are associated with more aggressive disease, with frequent recurrence and progression in children and adults {2074,2110,2174}.

Malignant transformation

Malignant change is not common, but occurs in the setting of smoking, irradiation, or other promoters {2112}. It is an exceptional event in the absence of predisposing factors {196,959,2144,2356}. The overall incidence of cancer development for irradiated patients is 14% and 2% for the non-irradiated {126}. Malignancies occur preferentially in the tracheobronchial tree in children, and in the larynx in adults {944}. Prognosis in children is poor {2422}. HPV 11 is most frequently associated with malignant transformation of RRP {487,1465,1521, 2112}, followed by HPV 16 {619} and HPV 18 {2226}.

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