Esophageal papillomatosis with stricture.

A 44-year-old man came to the Center for Voice and Swallowing Disorders complaining of recurrent dysphagia. He had a significant history of gastroesophageal reflux disease (GERD), and he had undergone endoscopy many years earlier at another institution.

Transnasal esophagoseopy (TNE) revealed the presence of a plaque-like, leukoplakic lesion in the mid-esophagus (figure, A) and a stricture with associated erosive changes distally adjacent to the gastroesophageal junction (figure, B). Biopsy of the proximal lesion demonstrated parakeratosis, hyperkeratosis, and squamous hyperplasia consistent with squamous papilloma. Following biopsy, a guide wire was inserted under direct vision through the port of the TNE scope, and the stricture was dilated with Savary dilators.

Esophageal squamous papillomas are rare lesions that typically do not cause symptoms in and of themselves. They are occasionally noted on endoscopy, often in association with GERD. Their histologic features are similar to those of papillomatous lesions in the airway, and polymerase chain reaction may identify human papillomavirus (HPV) DNA in the specimen. A stricture in the presence of papillomatosis should prompt a meticulous search for concurrent dysplasia or carcinoma. Surveillance of large sessile or diffuse papillomatous lesions may be warranted, given the theoretical potential for malignant degeneration.

From the Center for Voice and Swallowing Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org