3091 Squamous Papilloma of the Esophagus

Abstract

INTRODUCTION: Squamous esophageal papillomas are rare epithelial lesions typically discovered incidentally during esophagoduodenoscopy (EGD). The occurrence in patients undergoing EGD is less than 0.45 percent and the prevalence in the general population inferred from autopsy is less than 0.04 percent. Most patients are asymptomatic unless the lesion is large. The most common symptom is dysphagia. A majority of these lesions are found in the distal one third of the esophagus. They have not been demonstrated to progress to esophageal carcinoma. CASE DESCRIPTION/METHODS: Our patient was a 53 year old male with history of alcohol abuse who presented with new-onset seizure/syncope, six painless maroon stools, and coffee-ground emesis. The patient admitted to frequent diclofenac use. He was found to be anemic with a hemoglobin of 7.9 G/dL and had an elevated INR of 1.2. He was transfused two units of packed red blood cells and was started on a pantoprazole drip. Initial endoscopy revealed an island of tissue growth in the mid-esophagus and a bleeding duodenal ulcer that was injected with epinephrine, cauterized with gold probe, and clipped. Biopsy of the esophageal lesion was deferred to outpatient follow-up given the severity of the patient's presenting condition. Following the procedure, he was continued on the pantoprazole drip with transition to oral pantoprazole 40 mg daily. He had no further signs of gastrointestinal bleeding. Two weeks later, an EGD was performed. Biopsies were taken of the stomach mucosa and mid-esophageal mass. Gastric biopsy demonstrated mild chronic gastritis without dysplastic changes or helicobacter pylori. Esophageal biopsy demonstrated findings consistent with squamous papilloma. DISCUSSION: Squamous papilloma of the esophagus is a rare but benign lesion. Its macroscopic appearance is similar to other, less benign growths (verrucous squamous cell carcinoma, granulation tissue, or papillary leukoplakia). The etiology is unclear. Chronic mucosal irritation from GERD or esophagitis is the prevailing theory of pathogenesis, but HPV – strongly associated with cervical, anal, and oropharyngeal cancers (depending on viral serotype) – has been detected in some lesions. Thus, the gold standard for evaluation is biopsy. There are various proposed therapies for squamous papillomas including resection, cautery and radiofrequency ablation. Future research is needed in regard to treatment and surveillance for these lesions.