Issn Print: 0277-2116

Publication Date: 1999/01/01


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Clinical Quiz

Joseph F. Fitzgerald; Riccardo Troncone; Sandeep K. Gupta

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Excerpt

A 10.5-year-old girl presented to the Gastroenterology Clinic at the James Whitcomb Riley Hospital for Children with epigastric pain of 5 years' duration. The pain occurred daily and was often associated with nausea and chest pain. She experienced nonbilious, nonbloody emesis approximately once a month. The pain was worse during the school year; no other inciting/aggravating factors were identified. Her symptoms did not interfere with sleep. There was no weight loss or alteration of bowel habits. Her pediatrician instituted empiric therapy with antacid, ranitidine, and cisapride, which were of no reported benefit. Contrast radiography of the upper gastrointestinal tract obtained prior to referral was normal. Her family history was significant for GER and hiatal hernia in her mother, and irritable bowel syndrome in her maternal grandfather. The family structure was intact. Physical examination revealed a healthy-appearing, well-nourished female. The examination was normal; tenderness was not elicited on abdominal palpation and her stool was negative for occult blood. Screening laboratory studies were normal. Esophagogastroduodenoscopy was scheduled for further evaluation of her symptoms. A solitary lesion, 4 mm in greatest diameter, was noted in the proximal esophagus (Fig. 1); the surrounding mucosa was normal and no other abnormalities were noted. This lesion most likely represents:
Answer: C. The lesion was removed in toto. Histology revealed finger-like projections of lamina propria covered by hyperplastic squamous epithelium, characteristic of a squamous papilloma (Fig. 2). No dysplasia was evident.
Comment: The first histologically confirmed case of esophageal squamous papilloma was reported in 1959. The first report of endoscopic removal of this lesion was in 1974. They are usually small (generally ≤5 mm) and solitary. They are white or pink in color, soft to warty in texture, and exist in either sessile or pedunculated forms. They are rarely symptomatic and are often an incidental findings, as in the present case. Mucosal biopsy or polypectomy is safe and diagnostic. Their pathogenesis is not known, but gastroesophageal reflux and human papillomavirus (HPV) infection have been implicated (1). HPV can sometimes be demonstrated by immunocytochemical techniques. They are considered benign and malignant transformation is rare. Surveillance of these benign lesions, which are rarely symptomatic, appears unwarranted (1).
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