Distal Esophageal Squamous Papilloma Association with Eosinophilic Esophagitis and Gastroesophageal Reflux Disease: A Single Institution Large Cohort Study
Amy A Lo, Vanderlene L Kung, Haonan Li, Wanying Zhang, M Sambasiva Rao, Nirmala Gonsalves, Ikuo Hirano, Guang-Yu Yang. Northwestern University, Chicago, IL
Background: Squamous papilloma (SP) is small (< 1 cm), rare lesion most commonly found incidentally in the lower third of the esophagus during endoscopy. The majority are exophytic growths composed of fibrovascular cores covered by mature squamous epithelium and a minority are endophytic growths composed of an inverted papillary pattern covered by a smooth outer surface. Although there is no evidence that SP is a precursor lesion to squamous epithelial dysplasia or squamous carcinoma, the etiology of SP remains elusive. In the present study, we identified 84 SP cases and extensively analyzed if histologically diagnosed eosinophilic esophagitis (EoE) or clinically identified gastroesophageal reflux disease (GERD) correlated with SP development. We also used an immunohistochemical approach to determine if HPV was involved in SP development.
Design: SP was identified in 84 patients (52 female, 32 male, age 30-74) between 2002 and 2012. 57 had an exophytic and 27 had an inverted growth pattern. Chart review for each patient was performed to identify history of previous esophageal diagnosis or disorder. EoE was confirmed in previously diagnosed patients based on identification of at least three high power fields with >15 intraepithelial eosinophils. Immunohistochemistry (IHC) for Ki-67, p53, and p16 and in-situ hybridization for HPV were performed on the most recent exophytic cases (n=15). Expression patterns of each marker were compared to that of normal control esophagus.
Results: 48% of patients with SP (40 of the 84 cases) had concurrent or previously diagnosed EoE and/or GERD. Concurrent EoE was identified in 13 cases (10 exophytic, 3 inverted). 27 cases (18 exophytic, 9 inverted) were found to have a clinical history of GERD. Each of these SPs exhibited a typical morphology with occasional intraepithelial lymphocytes or eosinophils and no dysplasia. Ki-67 expression was limited to the proliferative zone, similar to control esophageal tissue. HPV, p16 and p53 were each negative in all cases.
Conclusions: We present the first study to demonstrate that EoE and GERD are highly associated with SP development. Although recent studies suggest HPV may be associated with SP in the distal esophagus, our study demonstrates that HPV is not associated with SP development. Our results indicate that EoE and GERD may play a significant role in SP development, and that the underlying mechanism/pathogenesis needs to be further elucidated.
Monday, March 4, 2013 1:00 PM
Poster Session II # 108, Monday Afternoon