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Segment of squamous papilloma of the esophagus showing finger-like projection and delicate vascularized tissue supporting broad layers of squamous epithelium.
Source publication
Squamous papilloma of the esophagus is a rare benign tumor; less than 200 cases have been reported in the literature. The prevalence of endoscopically diagnosed squamous papilloma of the esophagus has been reported in only a very few series, and varies from 0.01 to 0.43%. Clinical relevance and possible association with other pathological condition...
Context in source publication
Context 1
... for histological diagnosis. Histological diagnosis was made according to charac- teristic finger-like projections of tissue lined by an increased number of squamous cells and by uninflamed fibrovascular core containing small blood vessels with conserved normal cellular orientation and normal dif- ferentiation without signs of cytological atypia (Fig. ...
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Background/aims:
In head and neck squamous cell carcinoma, second primary gastrointestinal tumors are not uncommon. However, it is unclear whether a screening endoscopy is needed for detecting gastrointestinal neoplasm in patients with head and neck cancer. Therefore, we analyzed the prevalence and independent risk factors for second primary gastr...
Citations
... The reported prevalence is between 0.01% and 0.57%. [1][2][3] Most ESPs are solitary and incidentally found at endoscopy. The etiology of this benign lesion is controversial and largely unknown. ...
... Previous studies have shown a variable association with HPV with conflicting data. In some studies, the presence of HPV in ESPs was not detected, 2,4,8 whereas in others, up to or more than 50% of cases were found to harbor HPV. 1,5,7 The purpose of this study was to further investigate the possible association of 1 Department of Pathology and Laboratory Medicine, David Geffen HPV in our ESP series by using the up-to-date RNA in-situ hybridization (RNA ISH) technology, and by comparing study groups from the United States and China. ...
... Similarly, some other studies also showed the midesophagus to be the most common site for the detection of ESP (Table 2). 2,9,[11][12][13] Also in concordance with our findings, the frequency of ESP detection in the distal esophagus is similar to that in the proximal esophagus in a couple of earlier studies. 9,11 Together, these observations argue against reflux disease to be a common etiology for 5 reported 50% of their cases that were positive for HPV, also by PCR. ...
Introduction: The etiology of esophageal squamous papilloma (ESP) is largely unknown. Previous studies have shown a variable association with human papillomavirus (HPV) with conflicting data. The aim of this study was to further investigate the possible association of HPV in our ESP series using RNA in-situ hybridization (ISH) and compare study groups from the United States of America and China. Methods: Demographic and clinical data of patients with ESP were retrieved from the University of California Los Angeles (UCLA) (1/2016-3/2019) and Peking Union Medical College Hospital (PUMCH) (9/2014-3/2019) pathology databases. Hematoxylin and eosin slides were reexamined. Confirmed cases were examined by high- and low-risk HPV RNA ISH. Results: For the UCLA cohort, 13 429 upper endoscopies were performed and 78 biopsies from 72 patients were identified as ESP (F:M = 45:27, 66.7% > 45 years). Seventy-four (94.9%) biopsies were designated as polyps or nodules and 46.6% were located in the mid-esophagus. Other abnormal findings included gastroesophageal reflux disease (48.6%), hiatal hernia (38.9%), and esophagitis (36.1%). For the PUMCH cohort, 63 754 upper endoscopies were performed and 73 biopsies from 71 patients were identified as ESP (F:M = 48:23, 71.8% > 45 years). Sixty-four (87.7%) biopsies were designated as polyps or nodules and 57.5% were located in the mid-esophagus. Other abnormal findings included esophagitis (19.7%), and hiatal hernia (8.5%). No features of conventional cytologic dysplasia or viral cytopathic change were found. None of the cases was associated with squamous cell carcinoma, and none showed positive HPV RNA ISH results. Conclusions: No association was found between ESP and active HPV infection in our 2 cohorts. Other etiopathogenetic mechanisms, such as aging, might contribute to the development of these innocent lesions.
... 14 A similar finding was seen in Italy, with contradicting results from the same regions. 7,15 The results also did not show any consistent trend over time, and HPV was detected at various rates in earlier and recent studies (Table 3). Thus, these findings indicate that HPV detection rates in ESP are not related to recent HPV vaccination or changes in the HPV prevalence over time. ...
... Many studies, including ours, reported follow-ups of ESP cases. [7][8][9]16 In most studies, there was no recurrence after the removal of benign, non-dysplastic ESP. A French study showed a recurrence rate of 3.4% after the first ESP removal and 0% after the second one. ...
Background and Aim
Esophageal squamous papilloma (ESP) is a benign growth in the esophagus with unknown malignant potential. The mechanism underlying ESP formation is unknown, but human papillomavirus (HPV) infection has been proposed as a potential etiology. We sought to investigate the clinical characteristic of ESP in our population, review the current literature, and highlight the role of HPV.
Methods
This is a retrospective case–control study conducted at two referral centers. We selected the ESP population by free‐text search in the pathology department database and selected controls randomly from the general endoscopy population. Immunostains were used to evaluate ESP tissue for HPV.
Results
Between January 2016 and December 2021, we identified 66 patients with ESP, with a prevalence of 0.72%. ESP patients were younger, with a median age of 52 years ( P = 0.021), and more likely African American (34.4 vs 7.5%, P < 0.001) compared to controls. On endoscopy images, the growth was predominantly solitary (92.5%) in the middle of the esophagus (39.4%), with sizes ranging from 0.2 to 2.3 cm. A total of 62 patients had available tissue for HPV immune staining, and none tested positive for HPV. Eighteen patients had a follow‐up endoscopy with an average of 504.5 days follow‐up period. One patient developed esophageal squamous cell carcinoma during follow‐up.
Conclusions
We observed a higher prevalence of ESP compared to previous studies. The formation of ESP is multifactorial and partially explained by HPV infection in selected populations. The malignant potential of ESP is low but not negligible.
... There is no pathognomonic finding for ESCP at endoscopic evaluation. However, ESCP usually appears as a well delineated, round, sessile, verrucous-looking lesion, whitish or pinkish in color, with a soft consistency and a smooth or slightly rough surface (5). Although ESCPs are usually solitary and small (2 -6 mm in diameter), there are reports of giant esophageal papillomas (up to 5 cm) or esophageal papillomatosis (12,13). ...
Esophageal squamous cell papilloma is an uncommon epithelial lesion of the esophagus. Epidemiological data regarding esophageal squamous cell papilloma in children is scarce and consists of few case reports. Although the etiology of esophageal squamous cell papilloma remains unclear, chemical/mechanical irritation induced hyper-regenerative response of esophageal mucosa and human papillomavirus infection have been suggested as most probable causes. A case of a 14-year-old girl with cystic fibrosis and chronic dyspepsia had a 0.5 x 0.5 cm sessile, multilobulated, whitish and verrucous polypoid mass close to the lower esophageal sphincter removed. Histologically, a benign squamous papilloma was confirmed. Her dyspeptic symptoms suggestive for gastroesophageal reflux resolved after papilloma removal and anti-acid treatment. Esophageal squamous cell papilloma is an incidental finding at upper endoscopy. Gastroesophageal reflux disease may be responsible for distally localized papillomas. Due to its rarity in childhood, there are not any well-established management and surveillance guidelines. Esophageal squamous cell papilloma should be removed, when possible, because of the ambiguity about its malignant potential.
... The natural history of EPS remains unclear and from the literature, we found that the EPS clinical course varies from spontaneous regression to the development of ESCC. Some researchers recommended that EP should be removed because of the potential malignancy [69]. Nevertheless, is it necessary to provide positive treatments to each patient suffering from EPS? Some reports gave different puzzling ideas. ...
If esophageal papilloma (EP) is a rare condition, esophageal papillomatosis (EPS) is a distinct rarity. To date, only 53 well documented cases have been described in English literature. However, the number of reports on EPS significantly increased to over 40 cases during the past 20 years. Perhaps, this is due to the broad use of endoscopy and related research achievements. Most of the cases are individual and it seems that there are no associations between them. And up to now no guidelines can be followed. To further understand this exceedingly rare disease, we had a comprehensive review of the epidemiology, etiology, clinical manifestations, pathogenesis, treatment, and clinical course of EPS.
... None of these have turned into malignancies. Mosca et al. 9 examined 7618 upper GI endoscopy procedures and detected squamous papilloma in 9 patients. In our study, squamous papilloma was detected in 65 of 127,493 patients evaluated over a 12-year period. ...
... In our study, squamous papilloma was detected in 65 of 127,493 patients evaluated over a 12-year period. Looking at the studies in the literature, the rate of detecting squamous papilloma in upper GIS endoscopy has been reported between 0.045 and 0.26% 6,7,9 . Consistently with the literature, this rate was found 50.98 per 100,000 patients in our study. ...
Non-gastric upper gastrointestinal system polyps are detected rarely and mostly incidentally during upper gastrointestinal endoscopy. While the majority of lesions are asymptomatic and benign, some lesions have the potential to become malignant, and may be associated with other malignancies. Between May 2010 and June 2022, a total of 127,493 patients who underwent upper gastrointestinal endoscopy were retrospectively screened. Among these patients, those who had polyps in the esophagus and duodenum and biopsied were included in the study. A total of 248 patients with non-gastric polyps were included in this study. The esophageal polyp detection rate was 80.00/100,000, while the duodenal polyp detection rate was 114.52/100,000. In 102 patients (41.1%) with esophageal polyps, the mean age was 50.6 ± 15.1, and 44.1% (n = 45) were male. The most common type of polyps was squamous papilloma (n = 61, 59.8%), followed by inflammatory papilloma (n = 18, 17.6%). In 146 patients (58.9%) with duodenal polyps, the mean age of patients was 58.3 ± 16.5, and 69.8% (n = 102) were male. Brunner's gland hyperplasia, inflammatory polyp, ectopic gastric mucosa, and adenomatous polyp were reported to be the most prevalent types of polyps in the duodenum overall (28.1%, 27.4%, 14.4%, and 13.7%, respectively). It is crucial to identify rare non-gastric polyps and create an effective follow-up and treatment plan in the era of frequently performed upper gastrointestinal endoscopies. The epidemiological assessment of non-gastric polyps, as well as a follow-up and treatment strategy, are presented in this study.
... Oesophageal squamous cell papillomas are rare and benign epithelial lesions, occurring in 0.01-0.45% of persons undergoing OGD [1][2][3][4]. Although OSPs have been reported in almost every age group, the majority are diagnosed in the fourth to sixth decades of life and with a predilection for females [1][2][3][4][5]. ...
... Oesophageal squamous cell papillomas are rare and benign epithelial lesions, occurring in 0.01-0.45% of persons undergoing OGD [1][2][3][4]. Although OSPs have been reported in almost every age group, the majority are diagnosed in the fourth to sixth decades of life and with a predilection for females [1][2][3][4][5]. Most are asymptomatic and found incidentally during OGD for other indications; however, associated symptoms of dyspepsia, pyrosis, epigastric discomfort and dysphagia may be present [1][2][3][4]. ...
... Although OSPs have been reported in almost every age group, the majority are diagnosed in the fourth to sixth decades of life and with a predilection for females [1][2][3][4][5]. Most are asymptomatic and found incidentally during OGD for other indications; however, associated symptoms of dyspepsia, pyrosis, epigastric discomfort and dysphagia may be present [1][2][3][4]. ...
Oesophageal squamous papillomas (OSPs) are rare epithelial lesions, recognized to be benign but with reported malignant potential. We report a case of a 40-year-old female with chronic vomiting, subsequently found on oesophago-gastro-duodenoscopy to have two mid-oesophageal sessile polyps, the largest of which measured 10 mm. These were endoscopically resected with histopathology confirming an OSP without evidence of dysplasia or malignancy. The case under consideration reports the current literature on OSPs regarding their aetiology, malignant potential and optimal management.
... Studies evaluating for the presence of human papilloma viruses, which have been suggested as a potential cause, have been inconclusive. 3,5,6 In this case report, we describe for the first time a squamous papilloma of the upper oesophagus located near an inlet patch. Inlet patches, also known as heterotrophic gastric mucosa, are located in the proximal oesophagus and are capable of producing acid. ...
... 16 In human studies, some researchers have reported human papilloma virus (HPV) DNA being found within squamous papilloma lesions. 3,6 However, this has not been collaborated in other studies, 5,17 and the association between HPV and squamous papilloma of the oesophagus remains unproven and controversial. 15 I n o u r c a s e , w e p e r f o r m e d p 1 6 immunohistochemistry to evaluate for HPV, which returned a negative result. ...
Squamous papillomas are rare benign lesions that can be found in the oesophagus. It has been theorised that irritation of the esophageal mucosa leads to squamous papilloma formation. There is evidence to suggest that squamous papillomas of the distal oesophagus are related to irritation due to reflux of gastric acid. In this case report, we describe for the first time a squamous papilloma of the upper oesophagus located just distal to an inlet patch. Inlet patches consist of gastric mucosa located in the proximal oesophagus. They are capable of producing acid. This case raises the possibility that just as squamous papillomas of the distal oesophagus may be related to acid exposure from the reflux of gastric acid, squamous papillomas of the proximal oesophagus may be related to acid exposure from the locally-produced acid of inlet patches.
... ESPs are usually asymptomatic but may present with multiple clinical manifestations such as dysphagia, anemia, and hematemesis. It is generally detected incidentally in EGD, which is usually performed to investigate dyspepsia [5,6]. Although many lesions are detected during EGD, ESP is rarely observed, and it would be beneficial to increase the awareness of endoscopists on this topic [7]. ...
Esophageal squamous papilloma (ESP) is a rare benign tumor. ESP is generally detected incidentally during esophagogastroduodenoscopy, which is usually performed to investigate dyspepsia. We present three cases of this rare endoscopic finding. While two of our patients were asymptomatic, one had dysphagia, and the lesions were excised. Endoscopists should be able to make the differential diagnosis of papilloma detected in the esophagus and have knowledge about these lesions as they may carry malignant potential. Excision of papillomas is recommended for definitive diagnosis and treatment.
... Esophageal squamous papilloma (ESP) is a rare benign epithelial tumor of the esophagus with a prevalence of 0.01%-0.43% in patients undergoing upper endoscopy (1). They are benign epithelial lesions, found incidentally on mucosal examination and occur mostly in the adult population. ...
... They are often found as solitary, small, sessile lesions, although may also be found in a diffuse manner. The pathogenesis of ESP is uncertain but two theories have been proposed: mucosal irritation due to underlying inflammatory conditions such as gastroesophageal reflux disease (GERD) and human papilloma virus (HPV) associated epithelial changes (1). This report will discuss ESP in the pediatric population from a single center, discuss pathology findings, and provide a description of treatment modalities utilized in these patients. ...
... Chronic mucosal irritation due to GERD or HPV is thought to be the most common cause of ESP, and numerous studies have repeatedly demonstrated the presence of HPV in a subset of ESP. The literature reports that they are most commonly associated with HPV-subtype 16/18, although reports of subtype 6-11 are also documented (1,2). ...
Esophageal squamous papillomas (ESP) are rare benign tumors of the esophagus, which occur mostly in the adult population. Few cases have been reported in children and due to the low incidence, the pathogenesis of ESP is not entirely understood and the management is not standardized. It is thought that mucosal irritation from underlying inflammation, perhaps from GERD, trauma or human papilloma viruses can play a role in the formation of ESP. This report describes 4 cases of pediatric ESP from a single center and discusses the management of these lesions, including the use of antacids and the human papilloma viruses vaccine as treatment modalities. Given the limited data on ESP in the pediatric population, this report aims to describe the management of this condition in 1 center.
... Oesophageal squamous cell papilloma (OSP) is a rare benign epithelial lesion that is usually asymptomatic but can present with a spectrum of upper gastrointestinal symptoms [1]. With no gender predilection, the disease is commonly diagnosed in the forth and fifth decades of life [2]. ...
... Multiple punch biopsies were taken. 1 1 2 Histological examination of the specimen revealed squamous cell papilloma of benign appearance with prominent papillae and acanthotic stratified squamous epithelium without cellular atypia. The specimen tested positive for human papilloma virus (HPV). ...
... The prevalence of OSP has been reported to range from 0.01% to 0.45% [1]. However, this figure is amongst symptomatic patients undergoing oesophagoscopy, and the actual population prevalence is unknown and likely to be much lower. ...
Oesophageal squamous cell papilloma is a very rare entity with a limited number of reports in the literature. The exact aetiology is uncertain, and it commonly overlaps with gastro-oesophageal reflux. Human papilloma virus (HPV) is deemed responsible for some cases. Although incidental discovery during upper gastrointestinal endoscopy for other reasons is the commonest presentation, symptomatic cases do occur. Endoscopic excision is the standard treatment. We report a case of HPV-positive squamous papilloma of the upper oesophagus, presenting with lateralising throat pain and diagnosed with office transnasal oesophagoscopy. We also discuss features of HPV-positive oesophageal squamous papilloma and the role of transnasal oesophagoscopy as a recent diagnostic modality of increasing popularity.
