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Li Y, Lin F, Ling Q, Xiao Y, Xue X, Zhou W, Wang HL. Detection of Human Papillomavirus in Squamous Papilloma of the Esophagus. Int J Surg Pathol 2024; 32:748-757. [PMID: 37728123 PMCID: PMC11089826 DOI: 10.1177/10668969231195772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 09/21/2023]
Abstract
Introduction: The etiology of esophageal squamous papilloma (ESP) is largely unknown. Previous studies have shown a variable association with human papillomavirus (HPV) with conflicting data. The aim of this study was to further investigate the possible association of HPV in our ESP series using RNA in-situ hybridization (ISH) and compare study groups from the United States of America and China. Methods: Demographic and clinical data of patients with ESP were retrieved from the University of California Los Angeles (UCLA) (1/2016-3/2019) and Peking Union Medical College Hospital (PUMCH) (9/2014-3/2019) pathology databases. Hematoxylin and eosin slides were reexamined. Confirmed cases were examined by high- and low-risk HPV RNA ISH. Results: For the UCLA cohort, 13 429 upper endoscopies were performed and 78 biopsies from 72 patients were identified as ESP (F:M = 45:27, 66.7% > 45 years). Seventy-four (94.9%) biopsies were designated as polyps or nodules and 46.6% were located in the mid-esophagus. Other abnormal findings included gastroesophageal reflux disease (48.6%), hiatal hernia (38.9%), and esophagitis (36.1%). For the PUMCH cohort, 63 754 upper endoscopies were performed and 73 biopsies from 71 patients were identified as ESP (F:M = 48:23, 71.8% > 45 years). Sixty-four (87.7%) biopsies were designated as polyps or nodules and 57.5% were located in the mid-esophagus. Other abnormal findings included esophagitis (19.7%), and hiatal hernia (8.5%). No features of conventional cytologic dysplasia or viral cytopathic change were found. None of the cases was associated with squamous cell carcinoma, and none showed positive HPV RNA ISH results. Conclusions: No association was found between ESP and active HPV infection in our 2 cohorts. Other etiopathogenetic mechanisms, such as aging, might contribute to the development of these innocent lesions.
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Affiliation(s)
- Yuan Li
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
- Cedars-Sinai Biobank & Research Pathology Resource, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Fan Lin
- Department of Laboratory Medicine, Geisinger Health System, Danville, PA, USA
| | - Qing Ling
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yanmei Xiao
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaowei Xue
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Weixun Zhou
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Hanlin L. Wang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ahmad AI, Lee A, Nithagon P, Ayaz O, Altork N, Peppas S, Alzraikat S, Ayoubi R, Smith A, Dhanjal R, Jassal A, Rizzo SM, Cho WK. Esophageal squamous papilloma: Literature review and case-control retrospective study with histopathological exam of human papillomavirus. JGH Open 2023; 7:674-681. [PMID: 37908288 PMCID: PMC10615170 DOI: 10.1002/jgh3.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/29/2023] [Indexed: 11/02/2023]
Abstract
Background and Aim Esophageal squamous papilloma (ESP) is a benign growth in the esophagus with unknown malignant potential. The mechanism underlying ESP formation is unknown, but human papillomavirus (HPV) infection has been proposed as a potential etiology. We sought to investigate the clinical characteristic of ESP in our population, review the current literature, and highlight the role of HPV. Methods This is a retrospective case-control study conducted at two referral centers. We selected the ESP population by free-text search in the pathology department database and selected controls randomly from the general endoscopy population. Immunostains were used to evaluate ESP tissue for HPV. Results Between January 2016 and December 2021, we identified 66 patients with ESP, with a prevalence of 0.72%. ESP patients were younger, with a median age of 52 years (P = 0.021), and more likely African American (34.4 vs 7.5%, P < 0.001) compared to controls. On endoscopy images, the growth was predominantly solitary (92.5%) in the middle of the esophagus (39.4%), with sizes ranging from 0.2 to 2.3 cm. A total of 62 patients had available tissue for HPV immune staining, and none tested positive for HPV. Eighteen patients had a follow-up endoscopy with an average of 504.5 days follow-up period. One patient developed esophageal squamous cell carcinoma during follow-up. Conclusions We observed a higher prevalence of ESP compared to previous studies. The formation of ESP is multifactorial and partially explained by HPV infection in selected populations. The malignant potential of ESP is low but not negligible.
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Affiliation(s)
- Akram I Ahmad
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Arielle Lee
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Pichayut Nithagon
- Department of PathologyGeorgetown University School of MedicineWashingtonDCUSA
| | - Omair Ayaz
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Nadera Altork
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Spyros Peppas
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Sayel Alzraikat
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Reza Ayoubi
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Andrew Smith
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Rachna Dhanjal
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Ajay Jassal
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Samantha M Rizzo
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Won Kyoo Cho
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
- Department of Gastroenterology and HepatologyINOVA Medical SystemLeesburgVirginiaUSA
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Ekin N, Bestas R, Cetin A. Clinicopathological characteristics of patients with oesophageal squamous papilloma in Turkey and comparison with the literature data: The largest case series ever reported from Turkey. Int J Clin Pract 2021; 75:e14420. [PMID: 34053176 DOI: 10.1111/ijcp.14420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/24/2021] [Indexed: 01/23/2023] Open
Abstract
AIM Oesophageal squamous papilloma (ESP) is a rare tumoural lesion of the oesophagus considered to have a benign course. Due to the fact that they are rare lesions, there are not many publications with large case series on ESPs in the literature. In this study, we aimed to investigate the clinical, endoscopic and histopathological characteristics of ESPs. METHODS Reports of upper gastrointestinal endoscopies performed in the endoscopy unit within the Division of Gastroenterology of a tertiary care hospital in the Southeastern Anatolia Region of Turkey in the last 8-year period were evaluated retrospectively. Patients who were determined to have oesophageal polypoid lesions during the endoscopic procedure and were then diagnosed with oesophageal squamous cell papilloma in the histopathological examination were included in the study. RESULTS Of 11 541 patients who underwent upper gastrointestinal endoscopy, 51 were diagnosed with a total number of 55 ESPs (0.44%). In addition, 26 of these patients (51%) were female, and the mean age of the patients at the time of diagnosis was 42.2 years. The average size of the ESPs was 3.47 mm, and the most frequent location was the middle oesophagus with 51%. No statistically significant relationship was found between the location of ESPs and gender, endoscopy indication, oesophagitis, lower oesophageal sphincter dysfunction, hiatal hernia, gastroesophageal reflux disease (GERD) and Helicobacter pylori positivity. CONCLUSION In this study with the largest case series ever reported from Turkey, it was determined that ESPs were seen in younger ages in Turkey and were also smaller in size, which is not in agreement with the literature data. Besides, this study, in which ESPs were most frequently detected in the middle oesophagus, supports the view that GERD may not be the main factor in ESP aetiology.
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Affiliation(s)
- Nazım Ekin
- Department of Gastroenterology, Diyarbakır Health Sciences University Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Remzi Bestas
- Department of Gastroenterology, Memorial Dicle Hospital, Diyarbakır, Turkey
| | - Alpay Cetin
- Department of Pathology, Diyarbakır Health Sciences University Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Syrjänen S, Syrjänen K. HPV-Associated Benign Squamous Cell Papillomas in the Upper Aero-Digestive Tract and Their Malignant Potential. Viruses 2021; 13:v13081624. [PMID: 34452488 PMCID: PMC8402864 DOI: 10.3390/v13081624] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/18/2022] Open
Abstract
Squamous cell papilloma (SCP) in the upper aero-digestive tract is a rare disease entity with bimodal age presentation both at childhood and in adults. It originates from stratified squamous and/or respiratory epithelium. Traditionally, SCPs have been linked to chemical or mechanical irritation but, since the 1980s, they have also been associated with human papillomavirus (HPV) infection. Approximately 30% of the head and neck SCPs are associated with HPV infection, with this association being highest for laryngeal papillomas (76–94%), followed by oral (27–48%), sinonasal (25–40%), and oropharyngeal papillomas (6–7%). There is, however, a wide variation in HPV prevalence, the highest being in esophageal SCPs (11–57%). HPV6 and HPV11 are the two main HPV genotypes present, but these are also high-risk HPVs as they are infrequently detected. Some 20% of the oral and oropharyngeal papillomas also contain cutaneous HPV genotypes. Despite their benign morphology, some SCPs tend to recur and even undergo malignant transformation. The highest malignant potential is associated with sinonasal inverted papillomas (7–11%). This review discusses the evidence regarding HPV etiology of benign SCPs in the upper aero-digestive tract and their HPV-related malignant transformation. In addition, studies on HPV exposure at an early age are discussed, as are the animal models shedding light on HPV transmission, viral latency, and its reactivation.
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Affiliation(s)
- Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, Faculty of Medicine, University of Turku, 20520 Turku, Finland
- Department of Pathology, Turku University Hospital, 20521 Turku, Finland
- Correspondence:
| | - Kari Syrjänen
- Department of Clinical Research, Biohit Oyj, 00880 Helsinki, Finland;
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Rajendra S, Pavey D, McKay O, Merrett N, Gautam SD. Human papillomavirus infection in esophageal squamous cell carcinoma and esophageal adenocarcinoma: a concise review. Ann N Y Acad Sci 2020; 1482:36-48. [PMID: 33103249 DOI: 10.1111/nyas.14509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/05/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022]
Abstract
The causal link between high-risk human papillomavirus (hr-HPV) infection and cervical, anogenital, and some oropharyngeal malignancies has been established by both molecular and epidemiological data. The association between HPV and esophageal squamous cell carcinoma (ESCC) remains controversial, as is the true prevalence of HPV infection in ESCC. The wide range in reported rates reflects variability in the primary literature, with some larger scale case-control studies suggesting the infection rates range from 0% to 78%. Interactions between HPV and the Barrett's metaplasia-dysplasia-carcinoma sequence have been explored, and these studies have shown some conflicting data. Overall, systematic reviews have reported the prevalence of HPV-positive DNA in esophageal adenocarcinoma patients of between 13% and 35%. Postulated reasons for discrepancies in HPV prevalence rates in esophageal cancer include variations in testing methodology and assay sensitivities; technical issues, including the lack of a gold-standard primer; types of specimens utilized (fresh-frozen versus formalin-fixed tissue); geographical variation; cross-contamination; and small sample sizes. Thus, efforts must be undertaken to (1) standardize HPV testing, ideally in a central laboratory and utilizing tests that detect viral transcriptional activity; (2) avoid cross-contamination; and (3) recruit large numbers of patients to accurately ascertain HPV rates in esophageal malignancy.
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Affiliation(s)
- Shanmugarajah Rajendra
- Gastro-Intestinal Viral Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, New South Wales, Australia.,Department of Gastroenterology & Hepatology, Bankstown-Lidcombe Hospital, South Western Sydney Local Health Network, Bankstown, Sydney, New South Wales, Australia
| | - Darren Pavey
- Gastro-Intestinal Viral Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, New South Wales, Australia.,Department of Gastroenterology & Hepatology, Bankstown-Lidcombe Hospital, South Western Sydney Local Health Network, Bankstown, Sydney, New South Wales, Australia
| | - Owen McKay
- South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, New South Wales, Australia.,Department of Gastroenterology & Hepatology, Bankstown-Lidcombe Hospital, South Western Sydney Local Health Network, Bankstown, Sydney, New South Wales, Australia
| | - Neil Merrett
- Discipline of Surgery, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia.,Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Bankstown, Sydney, New South Wales, Australia
| | - Shweta Dutta Gautam
- Gastro-Intestinal Viral Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, New South Wales, Australia
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Fraga E, Almeida J, Camacho C, Simões J, Bernardes A. A case of esophageal carcinoma due to esophageal squamous papillomatosis. Int J Surg Case Rep 2020; 71:335-337. [PMID: 32492647 PMCID: PMC7264950 DOI: 10.1016/j.ijscr.2020.02.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/20/2020] [Accepted: 02/26/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Squamous Papilloma is a rare benign tumor of the esophagus. Esophageal squamous papilloma is thought to arise from a chronic inflammatory reaction due to mechanical or chemical irritant. ESP is usually considered to have a benign clinical course; however, some reports highlight the potential development of a malignancy. The development of extensive esophageal squamous papillomas also known as squamous papillomatosis of the esophagus is even less frequent. PRESENTATION OF THE CASE We present the case of an esophageal papillomatosis that developed into an invasive esophageal squamous cell carcinoma that was only diagnosed in the surgical specimen after minimally invasive Ivor-Lewis esophagectomy and in this case report, we discuss its etiology, diagnosis and treatment. CONCLUSION Extensive papillomatosis with continuous symptoms, especially persistent dysphagia, should always prompt a thorough analysis into a possible underlying malignancy.
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Affiliation(s)
- E Fraga
- General Surgery Department, Coimbra Hospital and University Center, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - J Almeida
- General Surgery Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - C Camacho
- General Surgery Department, Coimbra Hospital and University Center, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Simões
- General Surgery Department, Coimbra Hospital and University Center, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Bernardes
- General Surgery Department, Coimbra Hospital and University Center, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Mavilia MG, Wu GY. Esophageal squamous papilloma: A case series and literature review. J Dig Dis 2018; 19:254-256. [PMID: 28834319 DOI: 10.1111/1751-2980.12535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Marianna G Mavilia
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - George Y Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA
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