A Wart in the Esophagus

Abstract

A 17-year-old male patient who smokes and has been affected by Crohn’s disease since age 11 years was evaluated after methotrexate suspension. Methotrexate was stopped 4 months earlier because of nausea and the feeling of a foreign body in his throat. These symptoms developed after 4 years of therapy and disappeared soon after the suspension. At upper gastrointestinal endoscopy, a solitary whitishpink, sessile,mucosal nodule was observed in the distal esophagus, with a warty appearance (Figure). The surrounding mucosa was normal, without lesions suspicious for Crohn’s disease. Biopsy showed squamous hyperplasia without dysplasia or koilocytosis. Esophageal squamous papillomas are benign epithelial tumors (incidence <1%). Although large lesions can cause dysphagia, most lesions are asymptomatic and they result in incidental upper endoscopy findings. Papilloma can be endoscopically confused with glycogenic acanthosis or with verrucoid exophytic growth of atypical squamous cell cancer (verrucous carcinoma); differential