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Case Reports
. 2014 Apr 30:2014:bcr2013200195.
doi: 10.1136/bcr-2013-200195.

Oesophageal papillomatosis, not amenable to endoscopic therapies, treated with oesophagectomy

Sabo Tanimu  1 , Rafiullah, Jeffrey Resnick, Adedayo A Onitilo
Affiliations
Case Reports

Oesophageal papillomatosis, not amenable to endoscopic therapies, treated with oesophagectomy

Sabo Tanimu et al. BMJ Case Rep. .

Abstract

Oesophageal papillomatosis is a very rare entity, with only 10 cases (including ours) reported in the literature. We report a 51-year-old man with a 25-year history of dysphagia with solids and liquids who failed a trial of proton pump inhibitors and fluticasone. His initial endoscopy revealed a viliform mass with dense eosinophilic infiltrate without neoplasia. Endoscopic ultrasound examination revealed a 4×1.6×0.7 cm mucosal hemicircumferential lesion without regional adenopathy. Pathological findings from the oesophagectomy specimen confirmed oesophageal papillomatosis with no malignancy. Surveillance endoscopy 4 months later revealed the lesion had increased in size. Additional ablative therapies failed, and the patient underwent oesophagectomy. Surveillance CT of the chest and abdomen at 3 months and oesophagogastroduodenoscopy at 6 months were negative. This case illustrates that oesophageal squamous papillomatosis not amenable to medical therapy requires surgical treatment.

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Figures

Figure 1
Figure 1
Upper endoscopy revealed a 2 cm viliform, non-obstructing mass in the distal oesophagus. (A) Pre-endoscopic mucosal resection and (B) postendoscopic mucosal resection and argon plasma coagulation.
Figure 2
Figure 2
(A) CT of the chest and abdomen showing mild oesophageal thickening. (B) Endoscopic ultrasound examination showing a 4×1.6×0.7 cm mucosal hemicircumferential lesion without regional adenopathy.
Figure 3
Figure 3
Images of oesophagus after endoscopic mucosal resection and argon plasma coagulation. (A) After session 1. (B) After session 2, 4 weeks later.
Figure 4
Figure 4
Histological slide of squamous papilloma, characterised by an inflamed, exophytic squamoproliferative lesion with papillary architecture, replete with stromal cores harbouring congested small blood vessels. Note the squamous epithelium's orderly maturation and lack of cytological atypia (A) low magnification (B) intermediate magnification (H&E staining).
Figure 5
Figure 5
Surveillance endoscopic examination 4 months later demonstrates increase in the size of the lesion.
Figure 6
Figure 6
Oesophagogastroduodenoscopy examination 6 months after photodynamic therapy shows interval worsening of the lesion.
See this image and copyright information in PMC

References

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