Esophageal Squamous Papilloma in Children: A Single-center Case Series

Abstract

Objectives: Esophageal squamous papilloma (ESP) is a rare epithelial lesion most commonly seen in adults, with an unclear etiology and limited pediatric data available. The aim of this study was to provide an estimated prevalence of this lesion in our pediatric population, as well as to identify any demographic, clinical, or pathologic associations-including human papilloma virus (HPV) infection, which has been linked with ESP in adult literature. Methods: ESP cases at University Hospitals Rainbow Babies & Children's Hospital were identified by conducting a retrospective search through all esophagogastroduodenoscopies (EGDs) performed in children under 18 years old, from January 1, 2000 to December 31, 2014. Histopathology reports were analyzed including Fluorescence In Situ Hybridization (FISH) for HPV, and a comprehensive chart review was performed for demographic data. Results: Of 12,459 children who required an EGD, 10 children were identified with ESP on biopsy, with ages ranging from 2 to 17 years. This provides an estimated prevalence of 0.08% over the entire study period. Seventy percentage of patients underwent endoscopy for abdominal pain, and 40% presented with gastroesophageal reflux. Sixty percentage of lesions were in the proximal esophagus, and 80% of patients had isolated lesions. Notably, none of the lesions tested were positive for HPV on FISH analysis. Conclusions: ESP is a rare benign lesion found incidentally in the pediatric population. The prevalence at our institution was 0.08%. All samples tested for HPV via FISH analysis were negative. As a result, regular analysis for HPV may not be necessary in pediatric patients with ESP in the future.

Oesophageal squamous papilloma in paediatric population: a single-centre case series

“… 3 5 13 Tou and Al-Nimr reported in a 15-year case series a prevalence of OSP of 0.08% among children. 4 In contrast, in this report, we found a prevalence similar to the adult population; 0.4%. In a study conducted over 14 years, Pantham et al described an increased incidence of OSP in adults ranging from 0.13% in 2000 to 0.57% in 2013, related to more cases of HPV infections.…”

“… 17 18 OSP is a benign lesion, and there have been no malignancies associated with OSP found in the paediatric population; therefore, surveillance is considered unnecessary in children. 4 In our study, OSP lesions were removed using excisional biopsies, and no follow-up was performed. In contrast, an endoscopic follow-up in adults is encouraged by some authors, who have found an association with cancer.…”

“…In some cases, malignancy has been associated with OSP, especially in adults. 3 The prevalence of OSP ranges from 0.01% to 0.45%, 4 and few reports have been made on the paediatric population. There are no studies that evaluate the epidemiological characteristics of OSP and its association with HPV in our population.…”

HPV-Associated Benign Squamous Cell Papillomas in the Upper Aero-Digestive Tract and Their Malignant Potential

“…ESPs have also been detected in children, as found for all SCPs in different sites of the aero-digestive tract. Recently, Tou and Al-Nimr (2021) completed a retrospective search through all endoscopies (EGD) performed (with various indications) in children under 18 years of age from 2000 to 2014 in their pediatric hospital [ 106 ]. Of the 12,459 children who required an EGD, 10 children were identified with ESP in the biopsy, with ages ranging from 2 to 17 years.…”

Esophageal Squamous Papilloma in the Pediatric Population

“…Interestingly, a recent study failed to identify a relationship between the prevalence of HPV and the occurrence of ESP in pediatric patients. They concluded that reflex testing via in situ hybridization for HPV may not be beneficial or cost effective ( 10 ). We did identify HPV in a majority of our ESP cases, and feel there could be a benefit in reflex texting for HPV, which could help direct management and treatment such as the consideration of HPV vaccination.…”