Large Esophageal Papilloma

Video Endoscopic Sequence 1 of 9.

Large Esophageal Papilloma

This a 27 year old-male, This lesion was diagnosed on routine endoscopy

For further endoscopic information, download the video clip by clicking on the endoscopic image. Wait to be downloaded complete then Press Alt and Enter for ful screen ( Windows Media), Real Player: Ctrl and 3.All endoscopic images shown in this Atlas contain video clips. We recommend seeing the video clips in full screen mode.

The role of the human papilloma virus in esophageal
 cancer.

 



Endoscopic Imaging of a Large Esophageal Papilloma

Video Endoscopic Sequence 2 of 9.

Endoscopic Imaging of a Large Esophageal Papilloma

Esophageal papilloma is a rare endoscopic finding. Lesions are usually less than 5 mm, appear as a solitary sessile nodule, and are located in the middle or upper part of the esophagus. The surface has a warty-like structure. Malignant potential of esophageal papilloma is unknown. The essential differential diagnosis of esophageal papilloma comprises squamous cell, verrucous carcinoma, and hyperkeratotic lesions. Owing to missing data there are no therapeutical recommendations. In a pragmatic approach, lesions should be removed endoscopically.

 

Image and Video Clip of a Large Esophageal Papilloma

Video Endoscopic Sequence 3 of 9.

Image and Video Clip of a Large Esophageal Papilloma

Esophageal papilloma is a rare endoscopic finding with prevalence under 0.3%, without a predilection for gender. These benign tumors are usually less than 5 mm and appear as a solitary sessile nodule with a warty-like surface. However, very rarely they may also appear as large areas with irregular surface, as shown in the video demonstration. Most papillomas are located in the middle or upper part of the esophagus. They do generally not cause clinical symptoms.

Malignant potential of esophageal papilloma is unknown, whereas squamous papillomas of the oral cavity or oropharynx and anogenital lesions are defined as premalignancies.

Image and Video Clip of a Large Esophageal Papilloma

Video Endoscopic Sequence 4 of 9.

Image and Video Clip of a Large Esophageal Papilloma

The underlying etiology remains unclear. Infection with human papilloma virus (HPV) has been described, but more than 50% of esophageal papillomas have tested HPV negative. However, it should be kept in mind that HPV testing has a gray zone due to the fact that it does not test for all of the more than 60 existing HPV subtypes.3 Mucosal damage caused by gastroesophageal reflux have been implicated as a second risk factor for esophageal papilloma in the distal esophagus.

There are few individual case reports describing a malignant transformation of esophageal papillomatosis. This entity has a different phenotype compared to esophageal papilloma; one finds there a superficial, circumferential, rather than a nodulelike growth pattern.

Endoscopy a Large Esophageal Papilloma

SVideo Endoscopic Sequence 5 of 9.

Endoscopy a Large Esophageal Papilloma

Differential diagnosis of esophageal papilloma should comprise squamous cell, verrucous carcinoma, and hyperkeratotic lesions. As a rare differential diagnosis, an inflammatory fibroid polyp (composed of inflammatory cells including eosinophils and fibroblastic tissue) should be considered.

Video Endoscopic Sequence 6 of 9.

Endoscopy a Large Esophageal Papilloma

Some biopsies are obtained and the tissue is debrided

Owing to missing data, there are no therapeutical recommendations. In a pragmatic approach, lesions should be removed endoscopically. If the histology shows a papilloma, no further diagnostic or therapeutic steps are necessary. Recurrence is uncommon.




Endoscopy a Large Esophageal Papilloma

Video Endoscopic Sequence 7 of 9.

The partially debrided Papilloma with the forceps

 

Endoscopy a Large Esophageal Papilloma

Video Endoscopic Sequence 8 of 9.

It proceed to remove the rest with ablative therapy using argon plasma coagulator (APC)


 

Endoscopy a Large Esophageal Papilloma

Video Endoscopic Sequence 9 of 9.

Final State of ablative therapy of Esophageal papilloma using Argon Plasma Coaugulation

 

 

 

Endoscopic Image of Esophageal Papilloma

Video Endoscopic Sequence 1 of 4.

Endoscopic Image of Esophageal Papilloma

Most are asymptomatic, although they may cause dysphagia. The most frequent location is the posterior wall of the lower third of the esophagus, and the lesions are usually isolated. Endoscopically, the papilloma is a warty, polypoid mass that is firm to touch.

There are no pathognomonic symptoms for the typica esophageal squamous papilloma, unless the patient presents with the rare large papilloma or diffuse esophageal papillomatosis which may cause dysphagia.





 

 

Endoscopic Image of Esophageal Papilloma

Video Endoscopic Sequence 2 of 4.

Endoscopic Image of Esophageal Papilloma

Esophageal papilloma, an infrequent benign tumor, and esophageal squamous-cell carcinoma sometimes appear to be associated with human papillomavirus (HPV) infection, HPV being implicated in anogenital carcinogenesis. Human papillomavirus (HPV) has been implicated as a causative agent in a variety of human squamous cell carcinomas, including those of the skin, cervix, anogenital region, upper respiratory tract, and digestive track.

To date, more than 70 different HPV types have been identified; some of which are frequently associated with cancers and are considered high risk HPVs(types 16 and 18), whereas others give rise to warts and benign lesions and are considered low risk (types 6, 11, and 33).




Video Endoscopic Sequence 3 of 4.

Histologically in papillomas, mature squamous epithelium is arranged along a branched fibrovascular stalk with an exophytic, endophytic, or spiked architectural pattern

Esophageal squamous papillomas are rare, benign, tumors of an epithelial origin.

Histological findings of esophageal squamous papilloma.
Representative histological features of ESP.

 Shows a papillary projection lined with acanthotic
epithelium

Video Endoscopic Sequence 4 of 4.

Increased squamous hyperplasia with a fibrovascular core.

 

Esophageal Papilloma

Papilloma of the middle third of the esophagus.

Esophageal squamous papilloma (ESP) is a relatively rare,
benign, squamous epithelial tumor, which is generally small, single, round and elevated sessile lesions with smooth or rough surfaces. Two etiological factors of ESPs have been posited. One is hyper-regenerative response of the mucosa to chemical and mechanical irritation such as minor trauma, chronic food impaction, alcohol consumption, cigarette smoking, previous gastroesophageal surgery and gastroesophageal reflux diseases (GERDs). The mucosal irritant theory is clinically supported by the high prevalence of ESPs in the lower esophagus, the site most severely affected by GERDs. The other is human papilloma virus (HPV) infection. Since Syrjanen et al. demonstrated the presence of HPV antigens in ESPs, HPV infection
has been considered one of the etiological factors of ESPs,
although the exact pathogenetic importance of the HPV is
not yet clear.

 

 

 

 

 

 

 

 

 

Esophageal Papilloma

Esophageal squamous papillomas are usually a single,
round, elevated, sessile formation, well delineated from the
surrounding tissue. They range in size from 2mm up to 2cm
X 5cm, but average about 5-6mm. They tend to be
whitish/pink and have a soft consistency.

 

 

 

 

 

 

Video Endoscopic Sequence 1 of 3.

Esophageal Papilloma of the Lower Third.



Video Endoscopic Sequence 2 of 3.

Video Clip of Esophageal Papilloma of the Lower Third.




Video Endoscopic Sequence 3 of 3.

Endoscopic Image of Esophageal Papilloma of the Lower Third

Video Endoscopic Sequence 1 of 3.

Papilloma of the Esophagus with blood traces.

This is a 58 year-old male who suffered an upper
gastrointestinal bleeding due to a gastric varix.
Incidental finding shows a papilloma with hematic rest.


Video Endoscopic Sequence 2 of 3.

Another image and video clip of a papilloma with traces of blood

 


 

 

Video Endoscopic Sequence 3 of 3.

It proceed to eliminate with cautery and APC.

Video Endoscopic Sequence 1 of 2.

Papilloma of Oropharynx

In this image as well as in the video clip, there is a lesion
corresponding to a papilloma which is immediately after
upper esophageal sphincter.

 

 

Video Endoscopic Sequence 2 de 2.

Infection with human papillomavirus (HPV).


It is associated with oral and oropharyngeal cancer.


 

Papilloma oropharynx

Secuencia Video Endoscópica 1 de 3.

Papilloma anterior to the oropharynx

A 42-year-old male at a routine endoscopy finds this lesion near the oropharynx.

 

 

Papilloma oropharynx

Secuencia Video Endoscópica 2 de 3.

Another image and video of oropharyngeal papilloma


 

Some biopsies are obtained which reveal to be a papilloma.

Secuencia Video Endoscópica 3 de 3.

Some biopsies are obtained which reveal to be a papilloma.

 

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