RESUMEN
BACKGROUND: Human papilloma virus (HPV)-associated malignancies are considered to be sexually transmitted diseases. METHODS: We report a HPV-positive larynx cancer in an 18-year-old female clarinet player, despite vaccination with the quadrivalent HPV-6-11-16-18-vaccine Gardasil (Merck Sharp & Dohme Corp., West Point, Pennsylvania). The patient showed no evidence of genito-oral infection but showed some evidence for oral-oral HPV transmission through the sharing of saliva-infested clarinet mouthpieces. A right vocal cord lesion of benign appearance was removed via free margin resection. RESULTS: Histopathology revealed a microinvasive squamous cell carcinoma inside a zone of high-grade dysplasia that was positive for HPV-45. No tumor recurrence was observed during a 4-year follow-up evaluation. CONCLUSION: Benign lesion appearance and quadrivalent HPV vaccine status do not exclude HPV-associated malignancies. In our patient, the Gardasil vaccine did not provide crossover protection against HPV 45 infection. HPV-associated disease may not necessarily be transmitted via sexual practice patterns alone.