Squamous Cell Papilloma of the Esophagus: A Case Series Highlighting Endoscopic and Histologic Features

Abstract

Esophageal squamous papillomas are rare epithelial lesions typically discovered incidentally during EGD. Their prevalence is estimated to be less than 0.01% in the general population. We present three cases of esophageal squamous papillomas identified histologically. It may be possible to identify these lesions macroscopically. One study provided a positive predictive value of 88% for squamous papilloma utilizing the triad of exophytic growth, wart-like projections, and surface vessel crossing seen on narrow band imaging during endoscopy. The etiology is unclear. Chronic mucosal irritation from GERD or esophagitis is the prevailing theory of pathogenesis, but HPV has been detected in some lesions. The malignant potential of these lesions is considered controversial. There are documented cases demonstrating complications with squamous cell carcinoma, so we recommend removal of all esophageal squamous papillomas; however, the small absolute number of cases documented in the literature makes drawing any associations or conclusions between esophageal squamous papillomas and squamous cell carcinoma difficult. Further research is needed regarding treatment and surveillance. This case series helps contribute to the small but growing literature of this rare finding.

Esophageal Squamous Cell Papilloma: A Report of Three Cases

“…The endoscopic appearance of ESPs can be defined as millimetric solitary lesions originating from the mucosa, small, whitish-light pink with wart-like exophytic projections. These findings are not pathognomonic, and other diseases should be considered in the differential diagnosis, such as verrucous squamous cell carcinoma, granulation tissue, papillary leukoplakia, fibrovascular polyp, and leiomyoma [ 2 , 3 ]. Crossing surface vessels under narrow-band imaging, exophytic growth, and a wart-like shape are characteristic findings for ESPs.…”

“…EPS etiology is not fully determined. Gastroesophageal reflux disease, mucosal damage, esophagitis, HPV infection, alcohol, and tobacco are risk factors for ESP [ 2 , 6 , 8 ]. The relationship between HPV and ESP is a contentious issue, and the rate of HPV-positive ESP patients is reported in a wide range between 0% and 87.5% in the literature.…”

“…The relationship between HPV and ESP is a contentious issue, and the rate of HPV-positive ESP patients is reported in a wide range between 0% and 87.5% in the literature. These differences may be related to geographic variability in the frequency of oral HPV infection and the method of HPV testing [ 1 , 2 , 9 ]. Unfortunately, we do not know the HPV status of our patients.…”

“…Several suggested endoscopic treatments for squamous papillomas include forceps biopsy resection, cautery, photodynamic therapies, radiofrequency ablation, and mucosectomy for larger lesions. Esophagectomy can be performed in patients unsuitable for endoscopic follow-up and treatment (cases with extensive dissemination and suspected malignancy) [ 1 , 2 , 6 , 8 ].…”

Esophageal Squamous Cell Papilloma. Case Report

“…Characteristics that make them interesting findings for study. They are diagnosed by upper gastrointestinal endoscopy [1]. Its etiology is multifactorial, associated with human papillomavirus infection, chemical and/or mechanical irritation [2].…”