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Image of the Month

Endoscopic Appearance of an Esophageal Squamous Papilloma in a Pediatric Patient

Alkhouri, Naim MD; Wyneski, Matthew MD; Kay, Marsha MD; Wyllie, Robert MD

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Journal of Pediatric Gastroenterology and Nutrition: March 2008 - Volume 46 - Issue 3 - p 237
doi: 10.1097/MPG.0b013e3181658c33
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An 18-year-old man with a history of type 1 diabetes mellius and common variable immunodeficiency was referred for an EGD to rule out celiac disease. He was found to have a polypoid lesion 7 mm in diameter in the distal esophagus (Fig. 1A). Cold biopsies showed an esophageal squamous papilloma (ESP) that was negative for dysplasia (Fig. 1B). An immunostain for human papillomavirus (HPV) was negative.

F1-1
FIG. 1:
A, Endoscopic view of a small nodular squamous papilloma in the distal esophagus with normal surrounding mucosa. B, Histological features of the papilloma. Papillary fibrovascular core covered by hyperplastic squamous epithelium. Hematoxylin and eosin; original magnification × 20.

Esophageal squamous papilloma is a rare benign tumor occurring typically in adults. The prevalence of endoscopically diagnosed ESP varies from 0.01% to 0.4% in adult series (1). The pediatric prevalence is not known, but it is thought to be less. The typical appearance is a pale pink, sessile, or pedunculated nodule with a smooth or rough surface. Esophageal squamous papillomas are usually single and <1 cm. Most are incidental findings. Two etiologies have been proposed. One is mucosal irritation due to gastroesophageal reflux disease (GERD) or mucosal trauma with lesions located typically in the lower esophagus (2). Our patient had no symptoms of GERD and endoscopic biopsies were negative for GERD and for celiac disease. The other etiology is HPV infection; associated lesions are more common in the mid-esophagus. Esophageal squamous papillomas with HPV infection are more prevalent in Japanese patients (3).

The natural progression of ESPs is not known, but they are thought to be benign. Human papillomavirus infection, however, has been associated with an increased risk for esophageal cancer in some adult series. Pediatric gastroenterologists should be aware of these lesions. Special staining may differentiate those related to infection versus GERD. The etiology in our patient is not known, but it may relate to his underlying immunodeficiency.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

REFERENCES

1. Mosca S, Manes G, Monaco R, et al. Squamous papilloma of the esophagus: long-term follow up. J Gastroenterol Hepatol 2001; 16:857–861.
2. Sandvik AK, Aase S, Kveberg KH, et al. Papillomatosis of the esophagus. J Clin Gastroenterol 1996; 22:35–37.
3. Takeshita K, Murata S, Mitsufuji S, et al. Clinicopathological characteristics of esophageal squamous papillomas in Japanese patients—with comparison of findings from Western countries. Acta Histochem Cytochem 2006; 39:23–30.
© 2008 Lippincott Williams & Wilkins, Inc.