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164 ESOPHAGEAL PAPILLOMATOSIS: CASE REPORTS OF A RARE DISORDER OF THE ESOPHAGUS R Saravanan, SC Grover, G May, G Kandel, PP Kortan, NE Marcon Esophageal papillomatosis is a rare condition and is thought to have a benign clinical course. The pathogenesis of esophageal papillomatosis is not well understood but gastroesophageal reflux disease and human papillomavirus (HPV) infection have been implicated in its pathogenesis. Few case reports have been reported in the literature. We report two cases of this rare condition and review our experience in the management of these patients.
Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario
CASES: Patient demographics were obtained from a retrospective review of charts. Patients with a diagnosis of esophageal papillomatosis were included. PCR was performed to detect the presence of HPV in both cases.
Two patients were diagnosed with esophageal papillomatosis.
Case 1: A 70 year old male presented with dysphagia and endoscopy revealed extensive esophageal papillomatosis. The patient was followed for three years and, despite several imaging investigations and esophageal biopsies, dysplasia or malignant transformation was not documented. However, the lesions increased progressively in size and esophagectomy was recommended as there was a suspicion of malignant transformation. The esophagectomy specimen revealed evidence of verrucous carcinoma; PCR for HPV was negative.
Case 2: A 45 year old male presented with a gagging sensation in his throat and endoscopy revealed papillomatous lesions at 20 and 30 cm. Biopsies were in keeping with viral etiology and HPV 6/11 was detected on PCR. He was previously treated for oral papular lesions. The esophageal papillomatosis was completely removed using snare polypectomy.
CONCLUSION: Esophageal papillomatosis is rare and it is difficult to predict malignant transformation. Treatment in such patients should be individualized depending on patient age and the extent of the lesion. Until further data is available, we suggest regular endoscopic follow-up.