An Unusual Presentation of a Giant Squamous Papilloma in the Distal Esophagus

Abstract

Introduction: Benign tumors of the esophagus account for 20% of the esophageal lesions. Many of these tumors are small and asymptomatic, and few lesions attract clinical attention1. Esophageal squamous papilloma is an uncommon epithelial polypoid tumor and is usually identified as a solitary lesion of the lower esophagus 2. These sometimes cause dysphagia and can rarely cause significant outcomes such as aspiration pneumonia and esophageal obstruction. Here we report a case of a large esophago-gastric junction polyp causing similar symptoms. Case description: A 54-year-old male was brought to the emergency room with complaints of fever, dyspnea and postprandial vomiting. He reported cough and dysphagia for the past few days. Physical exam showed rales on right lung base and tachycardia. Blood work and chest X-ray showed right lower lobe lung infiltrate and sepsis. He was put on an antibiotic regimen. The chest CT revealed distended debris that filled the esophagus with mass effect along the trachea. He complained of worsening dysphagia and throat irritation. Endoscopic evaluation showed copious food in the distal esophagus, which was gently pushed down into the stomach. Subsequent exam showed a large prolapsing pedunculated polypoid 2 x 3 cm mass (Figure 1a) at the EG junction with luminal occlusion. The mass was mobile and exerted a ball-valve effect in the esophageal lumen, thereby worsening food transit to stomach. The large polyp was removed with snare (Figure 1b) and histological examination was consistent with squamous cell papilloma (Figure 3), with no dysplasia or malignancy. Post procedure, the patient had complete relief. Follow up endoscopy after few weeks showed complete healing of the site. (Fig -2) The patient had no further recurrence of symptoms.Figure 1Figure 3Figure 2Discussion: Benign esophageal lesions are common and can have a diverse spectrum of presentations in terms of clinical course and underlying pathologic features. They can sometimes cause chronic dysphagia and secondary achalasia leading to aspiration syndrome. A giant lesion causing dysphagia and aspiration as seen in our case is extremely rare. Endoscopic resection usually provides complete relief of symptoms.