Diffuse Extensive Esophageal Papillomatosis: A Rare Cause of Dysphagia

Abstract

Esophageal squamous papilloma is a benign epithelial tumor, usually seen as a solitary, small, white or pink, sessile or polypoid mass. The true incidence of esophageal papillomatosis is unknown, however, various studies estimate the incidence between 0.007-0.43%1. Fifteen percent of papillomatosis cases are seen as multiple lesions and even fewer are extensive disease2. We present a case of diffuse extensive papillomatosis. A 69 year old African-American gentleman with hypertension, COPD and alcohol abuse who presented with 2-3 months of dysphagia, and 40 pounds of weight loss over 10 months. Esophagogastroduodenoscopy (EGD) revealed a partially circumferential/obstructing friable necrotic appearing mass in the mid-esophagus which was biopsied. Distal to the large mass were small, circumferential, pearly, wart/finger-like exophytic growths which spared the very distal esophagus and the gastroesophageal junction. PET/CT scan revealed circumferential thickening and a hypermetabolic mid-esophageal wall over a length of 10cm, concerning for a primary esophageal cancer without evidence of metastatic disease. Initial pathology revealed no evidence of malignancy. The patient underwent two additional flexible EGDs with biopsies which were unrevealing. The patient finally underwent rigid esophagoscopy with biopsy with pathology revealing squamous papillomas. This was confirmed with pathology from a repeat EGD showing squamous papillomas without any evidence of malignancy. Our case is unique given the rarity of diffuse esophageal papillomatosis and highlights the challenges in diagnosing extensive disease as a non-malignant growth. Of note, 30 % of all lesions are associated with HPV and currently HPV on our patient remains pending. [1]. Syrjänen et al. Detection of human papillomavirus in esophageal papillomas: systematic review and meta-analysis. APMIS. 2013 May;121(5):363-74. [2]. Odze et al. Esophageal squamous papillomas. A clinicopathologic study of 38 lesions and analysis for human papillomavirus by the polymerase chain reaction. Am J Surg Pathol.1993 Aug;17(8):803-12.Figure 1Figure 2