Squamous Papilloma: An Unusual Esophageal Entity

Abstract

Purpose: We describe a case series of two patients who underwent EGD for different indications. The first case is of a 61 yr old male who presented with symptoms of intermittent dysphagia to solids for 2 months. Medical history included diabetes mellitus and CAD. He had quit smoking tobacco 40 years ago and denied alcohol use. He underwent EGD which showed a 1.5 cm exophytic mass in the distal esophagus. The lesion was removed with jumbo biopsy forceps. Pathology was consistent with squamous cell papilloma of the esophagus. Special stain did not detect Human papilloma virus DNA in the lesion. A follow up EGD was performed after 3 months which showed normal appearing mucosa. He improved symptomatically with no further complaints of dysphagia. The second case is of a 56 yr old male with hepatitis C who was referred for an EGD for symptoms of abdominal pain, nausea and weight loss. He denied dysphagia or any other esophageal symptoms. He had past history of tobacco and alcohol use.EGD showed a nodular lesion at 30 cm from incisors which was removed with jumbo biopsy forceps. Pathology was consistent with squamous papilloma without dysplasia. Squamous papilloma of the esophagus is a rare benign lesion of the esophagus. The prevalence ranges from 0.01% to 0.45%. It is usually asymptomatic and rarely causes dysphagia. The underlying etiology is unclear but chronic reflux disease, mucosal trauma and HPV infection have been implicated although most lesions are found to be HPV negative. Both patients described here had small hiatal hernia noted on EGD and chronic reflux could have played a role in papilloma formation. This entity presents as a ‘wart' like lesion most commonly in middle and distal esophagus and can be removed endoscopically. Histologically there are three different forms of squamous papilloma. The most common form has a branching core of lamina propria producing fronds that are covered by squamous epithelium. Occasionally the squamous epithelium has “koilocytotic changes with crinkled nuclei surrounded by clear cytoplasmic halos resembling the squamous cells of condylomas.” Malignant potential of the lesion is unknown and no guidelines exist regarding follow up of these lesions. Long term follow up studies have suggested removing the lesion endoscopically. Recurrence is uncommon.Figure: No Caption available.