1903 Esophageal Squamous Papilloma: A Rare Epithelial Tumor of Undetermined Significance

Abstract

INTRODUCTION: Esophageal squamous papilloma (ESP) is an uncommon lesion with less than 200 cases described. Although typically a benign lesion, the etiology remains uncertain. Currently, no guidelines exist for the management of esophageal squamous papilloma. CASE DESCRIPTION/METHODS: A 59-year-old woman presented with dysphagia; she reported symptoms of acid reflux and globus sensation. One year prior, esophagogastroduodenoscopy (EGD) was performed for these symptoms and revealed atrophic changes consistent with gastritis. Biopsy at that time was negative for H. Pylori infection. She was treated with PPI therapy, however her symptoms persisted. She endorsed intermittent dysphagia but denied weight loss or poor appetite. Physical exam revealed no palpable thyromegaly or epigastric tenderness. Repeat upper EGD revealed a white, 7 mm frond-like pedunculated polyp located 20 cm from the incisors (Figure 1). Endoscopic ultrasound (EUS) was performed, the origin of the lesion appeared to be within the superficial mucosa. The endosonographic borders were well defined, intact interfaces between the mass and adjacent structures suggested a lack of submucosal invasion (Figure 2). No was lymphadenopathy seen. The polyp was excised endoscopically (Figure 3), pathological review identified the specimen as an esophageal squamous papilloma, positive for Ki67 and HPV marker P16. The patient tolerated the procedure well and had no recurrence of symptoms after polypectomy. DISCUSSION: Often an incidental finding on endoscopy, ESP are most commonly found in adults over age 50 and typically involve the middle and distal thirds of the esophagus. ESP may be associated with dyspepsia but rarely cause obstruction. Purported etiologies include mechanical, chemical and viral insult to mucosa but is likely multifactorial. The malignant potential of ESP remains uncertain; although rare, several reported cases have been complicated by carcinoma. Studies to detect HPV DNA in ESP show variable percentage of HPV positivity. If HPV infection predisposes to ESP, this may explain cases of malignant conversion as HPV is a known cause of squamous cell cancer. ESP should be considered in patients over 50 years old presenting with dysphagia or GERD resistant to medical therapy. We recommend early recognition and removal of esophageal squamous papilloma due to ambiguity regarding malignant potential.