Malignant degeneration of esophageal squamous papilloma associated with the human papillomavirus

Benign esophageal tumors

Benign esophageal and paraesophageal masses and cysts are a rare but important group of pathologies. Although often asymptomatic, these lesions can cause a variety of symptoms and, in some cases, demonstrate variable biological behavior. Contemporary categorization relies heavily on endoscopic ultrasound and other imaging modalities and immunohistochemical analysis when appropriate. Minimally invasive options including endoscopic, laparoscopic, and thoracoscopic methods are increasingly used for symptomatic or indeterminate lesions.

Benign esophageal tumors: introduction, incidence, classification, and clinical features

Benign esophageal tumors comprise a diverse group of disorders that are rare in relation to malignant tumors or other benign conditions. The current article summarizes the literature with regard to the incidence and prevalence of benign tumors of the esophagus and discusses the various methods used to categorize these conditions. Summaries of important clinical features are provided for leiomyomas, esophageal cysts, fibrovascular polyps, papillomas, granular cell tumors and others.

Squamous cell papillomatosis of esophagus following placement of a self-expanding metal stent

The esophageal self-expanding metal stent has gained widespread acceptance for the management of tracheoesophageal fistulas and the palliative management of malignant esophageal strictures. The complications associated with its use can be classified as either immediate or delayed. The most frequent delayed complications include tumor ingrowth, stent migration, reflux of gastric contents, bleeding, and perforation. This case report illustrates an otherwise unrecognized delayed complication of a self-expanding metal stent. Near complete ingrowth of the stent by squamous mucosal hyperplasia occurred within six weeks of the metal stent's placement. This finding supports the hypothesis that mucosal injury and regeneration underlies the etiology of esophageal squamous cell papilloma formation.

Papillomavirus in esophageal papillomas and carcinomas

Human papillomavirus (HPV) has been implicated as a possible etiological factor in the development of squamous-cell carcinoma of the esophagus. Published data demonstrating HPV DNA in these lesions have been conflicting, varying between failure to detect HPV DNA to detection of up to 60% to 70% of the biopsies harboring HPV DNA, mainly HPV 16 and HPV 18. We have analyzed esophageal carcinoma samples from 2 high-risk areas, China and South Africa, using a degenerate PCR approach. All amplified products were cloned and sequenced. A broad spectrum of HPV types was demonstrated in 10/29 samples from China and 9/34 samples from South Africa. HPV types detected included mucosal types HPV 6, 18, 51, 52 and 57; cutaneous types HPV 9, 20, 24 and 25; and the putative new HPV types DL231, DL428 and DL436, with HPV 6/51, 6/57, 20/9 and 20/DL231 occurring as double infections. HPV 6 predominated (4 samples) in 11 esophageal papillomas originating from patients in Europe and tested for HPV DNA. Other HPV types present included HPV 20, DL284 and DL436. Another putative new HPV type, DL416, was identified in a dysplastic lesion of the esophagus.

Successful treatment of a squamous papilloma of the hypopharynx-esophagus by local injections of (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine

Human papillomaviruses (HPV) are associated with benign lesions and show specificity towards the location or tissues that they infect. HPVs are responsible for warts. Among more than 60 different HPV types known to occur in humans, a strong association has been found between types 16 and 18 and cervical cancer, and such an association is also suspected for types 31, 33, 35, 45, 51, 52, and 56. We describe the effects of (S)-1-(3-hydroxy-2-phosphonyl-methoxypropyl)cytosine (HPMPC), following local intratumoral injection, in a 69-year-old woman with hypopharyngeal and esophageal papillomatous lesions, polymerase chain reaction (PCR) positive for HPV types 16 and 18, that relapsed after surgery and that also failed to respond to Nd-Yag laser photocoagulation and alpha-interferon treatment (6 x 10(6) U five times a week for 4 weeks followed by three times a week for 2 months). HPMPC was given at 1.25 mg/kg, with a sclerosing needle, through the biopsy channel of a video-endoscope, directly into the tumor, from March until July 1993 at seven different occasions. The first four injections were given at an interval of 1 week at the level of the hypopharynx. The next three injections were given at an interval of 3 to 5 weeks. During the fourth to the seventh session, half of the dose was injected into the hypopharyngeal and the other half into the esophageal tumor. Three further injections of HPMPC were administered at the level of the esophageal tumor in September 1993 with 2-week intervals. After HPMPC treatment, the lesions became smaller and flat until they completely disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)