Esophageal papillomatosis complicated by squamous cell carcinoma

Abstract

Esophageal papillomatosis is a very rare condition that is believed to have a benign clinical course. Recent reports underscore the potential development of a malignancy in association with squamous papillomatosis of the esophagus. A case of esophageal papillomatosis complicated by the development of esophageal invasive squamous cell carcinoma diagnosed after esophagectomy, despite multiple nondiagnostic endoscopic biopsies, is described. The patient also developed squamous cell carcinoma in the oral cavity and pyloric channel. The finding of extensive esophageal papillomatosis and unremitting dysphagia symptoms should prompt investigations into an underlying associated malignancy.

Figure 1

Photomicrograph of early biopsy of the esophageal lesions. Note the papillary architecture. Acute inflammation is present within the epithelium (arrow), associated with nuclear changes considered at the time to be reactive in nature (hematoxylin and eosin stain, original magnification ×100)

Figure 2

Endosonographic image of a hypoechoic mucosal thickening (arrow) with intact submucosa

Figure 3

Photograph of esophagectomy specimen. Note the loss of the normal smooth, white squamous epithelium, replaced by fleshy pink nodular tissue (asterisk)

Figure 4

Photomicrograph of the invasive squamous cell carcinoma. Nests of well-differentiated malignant squamous cells are invading the muscularis propria (arrow) (hematoxylin and eosin stain, original magnification ×25)

Figure 5

One-year postesophagectomy endoscopic image of the pyloric channel mucosal irregularity

Figure 6

Endoscopic image of the pyloric channel mass

Figure 7

Photomicrograph of the pyloric lesion. Note the sharp division between gastric antral type mucosa (thick arrow) and the invasive squamous epithelium (thin arrow) (hematoxylin and eosin stain, original magnification ×40)