Esophagus
Benign tumors
Squamous papilloma
Author: Yukihiro Nakanishi, M.D., Ph.D.
Deputy Editor-in-Chief: Raul S. Gonzalez, M.D.
Last author update: 22 June 2020
Last staff update: 13 May 2021
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Squamous papilloma[TIAB] esophagus
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Prognostic factors | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Sample pathology report | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Nakanishi Y. Squamous papilloma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/esophagussquamouspapilloma.html. Accessed April 24th, 2024.
Definition / general
- Benign esophageal epithelial polyp composed of squamous epithelium with a papillary growth pattern
Essential features
- Papillary proliferation of nondysplastic squamous epithelium with fibrovascular cores of lamina propria
- Etiologic factors include irritation (alcohol consumption, smoking and reflux esophagitis, metal stent and chronic food impaction), infection (HPV infection) and genetic syndromes (Goltz-Gorlin syndrome and angioma serpiginosum)
- Human papilloma virus infection rate: 10.5 - 57%
- Often seen in the distal esophagus in the U.S. (58.3 - 70%) and the middle esophagus in Asian countries (52.6 [Japan] - 57.5% [Taiwan])
Terminology
- Squamous cell papilloma
ICD coding
- ICD-O: 8052/0 - squamous cell papilloma, NOS
Epidemiology
- Incidence: 0.20 - 0.42% (World J Clin Cases 2017;5:134, World J Gastroenterol 2016;22:2349, Acta Histochem Cytochem 2006;39:23 )
- Average age: 48.9 - 59.2 years (World J Clin Cases 2017;5:134, Dis Esophagus 2017;30:1, World J Gastroenterol 2016;22:2349, Acta Histochem Cytochem 2006;39:23, Am J Surg Pathol 1993;17:803)
- Reported male to female ratio varies from roughly 5:2 to 1:5 (World J Gastroenterol 2016;22:2349, Am J Surg Pathol 1993;17:803)
- Average size: 3.8 - 5.0 mm (World J Clin Cases 2017;5:134, World J Gastroenterol 2016;22:2349, Acta Histochem Cytochem 2006;39:23, Am J Surg Pathol 1993;17:803)
- Most cases solitary (80 - 92%) (Dis Esophagus 2017;30:1, World J Gastroenterol 2016;22:2349, Acta Histochem Cytochem 2006;39:23, Am J Surg Pathol 1993;17:803)
Sites
- Distal esophagus in the U.S. (58.3 - 70%) (Am J Surg Pathol 1993;17:803, Dis Esophagus 2017;30:1)
- Middle esophagus in Asian countries (52.6 [Japan] - 57.5% [Taiwan]) (Acta Histochem Cytochem 2006;39:23, World J Gastroenterol 2016;22:2349)
Pathophysiology
- Chronic mucosal irritation or HPV infection followed by hyperregenerative response / proliferation of squamous epithelium
Etiology
- Hyperplasia of the squamous epithelium due to chemical irritation (alcohol consumption, smoking and reflux esophagitis), mechanical irritation (metal stent and chronic food impaction), infection (HPV infection), genetic syndromes (Goltz-Gorlin syndrome and angioma serpiginosum) (World J Gastroenterol 2017;23:2246, Eur J Hum Genet 2007;15:543, Am J Surg Pathol 1993;17:803, Acta Histochem Cytochem 2006;39:23)
- Most papillomas in the lower esophagus are associated with gastroesophageal reflux disease (GERD) (Am J Surg Pathol 1993;17:803)
- Human papilloma virus infection rate varies (10.5 - 57%) (Am J Surg Pathol 1993;17:803, Acta Histochem Cytochem 2006;39:23, Dis Esophagus 2017;30:1)
Clinical features
- Usually asymptomatic
- Rarely, dysphasia and heartburn (Clin Gastroenterol Hepatol 2016;14:A21)
- Incidentally found small warty polypoid lesion in the esophagus
Diagnosis
- Incidentally found on endoscopy
- Confirmed on biopsy
Prognostic factors
- No known prognostic factors (progression to dysplasia or carcinoma is extremely rare)
Case reports
- 3 year old girl with history of Goltz syndrome presented with esophageal squamous papillomatosis (J Pediatr Gastroenterol Nutr 2018;66:e132)
- 42 year old man with multiple esophageal squamous papillomas (ACG Case Rep J 2019;6:e00180)
- 44 year old woman with squamous cell carcinoma in situ arising from esophageal squamous papilloma (Clin Endosc 2019;52:72)
- 64 year old man with history of Cronkhite-Canada syndrome presented with papilloma-like lesions of the esophagus (Dig Liver Dis 2020;52:352)
- 65 year old woman with carcinoma cuniculatum initially misdiagnosed as benign squamous papilloma (Endoscopy 2014;46:E531)
Treatment
- Endoscopic resection / polypectomy
- Ablation by radiofrequency (World J Gastrointest Endosc 2015;7:290)
- Cryotherapy (ACG Case Rep J 2019;6:1)
Clinical images
Images hosted on other servers:
Squamous papilloma with warty surface
Squamous papillomatosis
Gross description
- Small (usually < 5 mm), sessile, whitish, warty polypoid lesion
Microscopic (histologic) description
- Papillary proliferation of nondysplastic squamous epithelium with fibrovascular cores of lamina propria
- Koilocytes can be seen
- Most commonly, exophytic but rarely, endophytic and tentacular type proliferation (Mayo Clin Proc 2019;94:1551)
- No dysplasia is seen (progression to dysplasia or carcinoma is extremely rare)
Microscopic (histologic) images
Contributed by Yukihiro Nakanishi M.D., Ph.D.
Esophageal polypoid lesion
Sample pathology report
- Esophagus, mid, polyp, biopsy:
- Squamous papilloma (see comment)
- Comment: It is negative for dysplasia or carcinoma.
Differential diagnosis
- Verrucous carcinoma / carcinoma cuniculatum (Endoscopy 2014;46:E531):
- Usually large mass
- Hyperkeratosis, dyskeratosis and nuclear atypia in addition to papillary growth and acanthosis
- Squamous cell carcinoma:
- Cytological and architectural atypia
- Glycogenic acanthosis:
- Acanthosis with clear cytoplasm
- No papillary proliferation
- Epidermoid metaplasia / epidermization:
- Occasionally, shows papillary proliferation but usually with prominent granular layer and orthokeratosis
Additional references
Board review style question #1
Which of the following is true about the lesion shown in this picture?
- Koilocytes can be seen
- Patients need aggressive treatment including chemotherapy and radiation
- Patients present with dysphagia
- Prominent granular layer is one of the characteristic findings
Board review style answer #1
A. Koilocytes can be seen in squamous papilloma of the esophagus.
Comment Here
Reference: Squamous papilloma
Comment Here
Reference: Squamous papilloma
Board review style question #2
Which of the following is true about squamous papilloma of the esophagus?
- Almost all squamous papillomas of the esophagus are associated with human papilloma virus infection
- Gastroesophageal reflux disease is one of the etiologic factors
- Most patients are young women with human papilloma virus infection
- Usually it is seen in the cervical esophagus
Board review style answer #2
B. Gastroesophageal reflux disease is one of the etiologic factors.
Comment Here
Reference: Squamous papilloma
Comment Here
Reference: Squamous papilloma
