Squamous Papillomas of the Esophagus: A Clinicopathologic Study of 171 Patients Revealing a Possible Association with Eosinophilic Esophagitis
James E Lapinski, Keith D Bohman, William E Katzin, Robert E Petras. Ameripath Institute of Gastrointestinal Pathology, Oakwood Village, OH
Background: Squamous papillomas, benign exophytic papillary proliferations of squamous epithelium and fibrovascular tissue, typically occur in the mid and distal esophagus. In adults, an association with reflux has been postulated. We have noticed cases containing increased numbers of intraepithelial eosinophils. Therefore, we reviewed our experience with squamous papillomas to determine whether there is an association with eosinophilic esophagitis.
Design: The surgical pathology archives at our institution from 2000-2009 were searched for cases of squamous papilloma. These were compared to a control cohort of patients with esophageal biopsy specimens matched for age, gender, and year of diagnosis. In each case, the patient age, gender, and presenting symptoms were recorded and the results of pathological review and comorbid conditions noted. Groups were compared using the chi-square test.
Results: The 171 patients (115 women) ranged in age from 18 to 86 years (mean = 52.8). Three patients had two papillomas. Based on biopsy specimens obtained separately from the papillomas, the histological inflammatory status of the esophagus was known in 93 patients. Seventy-eight showed inflammation including reflux-related changes (59 patients), histological eosinophilic esophagitis defined as >15 intraepithelial eosinophils per high magnification field (15 patients), and mucosal candidiasis (4 patients). Compared with the control cohort, squamous papillomas were more frequently associated with inflammation (p<0.0001), reflux-related histology (p=0.0002), and histological eosinophilic esophagitis (p<0.0001). No koilocytotic changes, squamous dysplasia, or carcinoma was encountered in either cohort. Repeat upper endoscopy with esophageal biopsy occurred in 18 patients; one patient had persistence/recurrence of esophageal papilloma at 3 months.
Conclusions: We conclude that, in adult patients, esophageal squamous papillomas show no histological evidence of HPV cytopathic effect and are not associated with squamous dysplasia or carcinoma. This study confirms a high rate of comorbid reflux but also reveals a possible association with histological eosinophilic esophagitis.
Monday, March 19, 2012 1:00 PM
Poster Session II # 90, Monday Afternoon