Squamous papilloma of the esophagus. Clinical and pathological observations based on 172 papillomas in 155 patients

INTRODUCTION: The papilloma of the oesophagus is a rare disease. The pathogenesis and biological features of the disorder are not clearly known. AIMS: The purpose of the present paper is to outline the clinical and pathological significance of the papilloma of the oesophagus as detected in the authors' endoscopic laboratory. METHODS: Endoscopic examinations were carried out with a flexible endoscope. The alterations in the oesophagus were removed by biopsy forceps in order to perform histological investigations, large-sized ones were removed by way of endoscopic mucosectomy. To assess the structure major alterations and their circumstances relative to their environment, endoscopic ultrasonography was performed, as well. Histological examination was done in formalin-fixed slides embedded in paraffin and dyed with hematoxiline eosine. HPV detection was done through polymerase chain reaction (PCR). RESULTS: During the 35 years a total of 59.056 upper panendoscopic examinations were carried out. Planocellular papilloma were detected in 155 patients (0.26% of the total number of patients). 85 of the patients were female, 70 were male. The vast majority of papilloma cases were solitary (142 patients). A minority--13 patients--had multiplex alterations. Most often, the papillomas were sessile changes, most often located in the middle and upper part of the intrathoracic section of the oesophagus. The probability of the papilloma can be established on the basis of the findings of endoscopic morphology, as well. This, however, has to be supported by a histological examination. In the majority of the cases the papillomas of the oesophagus can be removed by endoscopical biopsy forceps, because most often the alterations were only a few millimetres in size. Larger papillomas can be removed by way of endoscopic mucosectomy. Examining the transformation of papillomas into carcinomas, no papilloma was found which directly transformed into a carcinoma. Synchronically occurring planocellular carcinoma was found in the oesophagus of only 2 out of the 155 patients. During the follow-up examination of patients, recurrence of the disease was found only in one patient. The frequency of the human papilloma virus in papilloma of the oesophagus: the authors were able to detect the presence of HPV by way of PCR technique in 12 out of 26 cases (46.2%). With the expectation of 3, they were all viruses with a high risk of cancerous transformation. CONCLUSION: The squamous papillomas of the oesophagus are begin tumors. Papillomas is not caused by hiatus hernia or reflux oesophagitis. The distinct localization of the two different types of alternations also suggests a non-reflux oesophagus origin of the papilloma. The reason is that papillomas are most often located in the middle and upper part of the intrathoracic section of the esophagus--on the other hand, reflux esophagitis is located in the lower section. It is now generally accepted that papillomas of the mucous membrane covered by multiple planocellular layers are caused by HPV. The identical localization of the papillomas and planocellular cancer in the oesophagus refer to potentially identical etiology (HPV infection), and it may rarely occur that the papillomas wil in fact transform into carcinoma. Papillomas of the esophagus is a rare disorder. Its detection is in part important in order to distinguish it from planocellular carcinoma (especially carcinoma verrucosum), In part it indicated the HPV-infection of the oesophagus, or in HPV-positive cases it may be regarded as a precancerous state. For all this, it is important that the papilloma should be recognised by way of endoscopic examination, removed and a precancerous state should be taken into consideration.