Gastroenterology
Volume 137, Issue 3 , Page 790, September 2009

Atypical Esophagitis

  • Helmut Neumann, MD

      Affiliations

    • Division of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
    • ,
  • Dörthe Kuester, MD

      Affiliations

    • Department of Pathology, Otto-von-Guericke University, Magdeburg, Germany
    • ,
  • Klaus Mönkemüller, MD, PhD, FASGE

      Affiliations

    • Department of Internal Medicine and Gastroenterology, Marien Hospital, Bottrop, Germany

published online 30 July 2009.

Article Outline

 

Question: A 74-year-old man was admitted because of progressive dysphagia to solids of 6 months duration. His past medical history was unremarkable. The patient mentioned that he had been admitted for similar complaints on 4 occasions during the last 4 years. Each time he underwent esophageal dilation with improvement of his symptoms. He denied allergies, skin problems, or any rheumatologic complaints. On physical examination, he appeared well nourished, without any signs of wasting. The laboratory data were all within reference ranges. Esophagogastroduodenoscopy (EGD) disclosed mucosal polypoid lesions covering the entire circumference of the esophageal mucosa, starting at 20 cm distance from the teeth and extending to 30 cm (Figure A). The proximal esophagus was stenosed, but the gastroscope could be advanced with minor pressure. From 30 cm to the Z-line, the mucosa seemed to be fibrosed, but no polyps were present. The remaining EGD was normal. Multiple biopsies were obtained. Histology revealed polypoid structures with multiple finger-like projections (Figure B). Further sectioning showed that the lesion consisted predominantly of broad layers of squamous epithelium, with marked hyperplasia and hypertrophy of all squamous epithelial layers (Figure C).

What is the diagnosis?

Look on page 1188 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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Answer to the Clinical Challenges and Images in GI Question: Image 2 (page 790): Esophageal Papillomatosis 

Squamous papilloma or papillomatosis of the esophagus is a rare condition, being found in 0.01%–0.43% of upper endoscopies.1 The etiology of esophageal papillomatosis is unclear. Whereas a role for human papilloma virus has been proposed, this virus is found in <40% of patients.1, 2, 3 Esophageal papillomas are usually single polypoid lesions found in the middle esophagus, but occasionally many lesions are present and the condition is then called papillomatosis.1, 2, 3 Most patients are asymptomatic and papillomas are encountered during EGD performed for nonesophageal symptoms.1, 2, 3 However, when the lesions are large or diffuse, most patients present with dysphagia. Other described esophageal symptoms in patients with esophageal papillomatosis are heartburn and regurgitation.2, 3 Whether gastroesophageal reflux disease plays a role remains a matter of debate.2, 3 Although a potential role for malignant transformation has been proposed, most reports do no confirm this association.1, 3 Treatment usually consists of resecting the single or multiple lesions. In cases such as in our patient, treatment is aimed a relieving the dysphagia with dilation using a bougie or balloon.

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References 

  1. Mosca S, Manes G, Monaco R, et al. Squamous papilloma of the esophagus: long-term follow-up. J Gastroenterol Hepatol. 2001;16:857–861
  2. Colina F, Solís JA, Muñoz MT. Squamous papilloma of the esophagus (A report of three cases and review of the literature). Am J Gastroenterol. 1980;74:410–414
  3. Carr NJ, Monihan JM, Sobin LH. Squamous cell papilloma of the esophagus: a clinicopathologic and follow-up study of 25 cases. Am J Gastroenterol. 1994;89:245–248

 Conflicts of interst The authors disclose no conflicts.

 For submission instructions, please see the Gastroenterology web site (www.gastrojournal.org).

PII: S0016-5085(09)00511-3

doi:10.1053/j.gastro.2009.02.082

Gastroenterology
Volume 137, Issue 3 , Page 790, September 2009