Diffuse esophageal papillomatosis complicated by squamous cell carcinoma

Abstract

A 47-year-old male non-smoker, with a history of myotonic dystrophy, was referred to our endoscopy department following progressive dysphagia and significant weight loss. Esophagogastroduodenoscopy revealed a superficially spreading verrucous growth, extending downward for approximately 10 cm (Fig. 1). Furthermore, a separate proximal ulcerating mass was identified, located 2 cm distally of the upper esophageal sphincter. Staging with positron emission tomography (PET) revealed an ill-defined mass originating from the proximal esophagus with several enlarged para-esophageal lymph nodes (Fig. 2, right). Also, a linear diffuse tracer uptake was identified, extending into the distal esophagus, corresponding on biopsy with extensive papillomatosis, findings compatible with diffuse esophageal squamous papillomatosis (DESP) (Fig. 2, left). Fig. 2Left: histological evaluation (H&E staining), showing extensive papillomatosis, focal hyperkeratosis and parakeratosis, findings compatible with esophageal papillomatosis. Right: Positron Emission Tomography-images, revealing a high-uptake primary tumor in the proximal esophagus and a separate linear tracer uptake extending into the distal esophagus. View Large Image Figure Viewer Download Hi-res image