Larkin Community Hospital South Miami, FL, United States
Emmanuel A. McDonald, DO1, Zaid Rana, DO, MPH2, Paul Khoury, 3, Amir Riaz, MD4, Mark Avila, MD, MBA5, Karthik Mohan, DO1 1Larkin Community Hospital, South Miami, FL; 2Larkin Community Hospital, Miami, FL; 3St. George's University School of Medicine, Coral Gables, FL; 4Cleveland Clinic Florida, Weston, FL; 5Larkin Community Hospital, Kendall, FL
Introduction: Human Papilloma Virus (HPV) is a common infection found in patients of all ages. The incidence and prevalence rates of HPV are relatively variable, but the consensus is that nearly every sexually active American will contract HPV in their lifetime. With over 150 strains of HPV, esophageal squamous papillomas have rarely been documented in the esophagus.
Case Description/Methods: A 67-year-old male with PMHx of cirrhosis and familial colon cancer and no known skin conditions, was referred to GI due to complaints of progressive dysphagia. After a full work up the patient was scheduled for an esophagogastroduodenoscopy (EGD). On EGD, the patient was noted to have a partially obstructing mass in the middle third of his esophagus. He was referred for endoscopic ultrasound (EUS) due to a suspected esophageal neoplasm. His endosonographic findings showed an isoechoic, 4 cm, non-bleeding mass in the middle third of the esophagus 36 cm from the incisors, extending to 41 cm, causing partial obstruction, characterized by intraluminal growth. Also noted was hyperechoic and heterogeneous echogenicity in the left lobe of the liver, and an anechoic lesion in the body of the pancreas suggestive of a cyst measuring 8mm by 6 mm. The pancreatic lesion showed no obvious communication with the pancreatic duct. The surgical pathology report of the esophageal mass indicating verrucous hyperplasia consistent with a benign verruca. The pathology report of the esophageal mass noted no dysplastic or malignant changes, and a negative test for Barrett’s Esophagus and fungal organisms.
Discussion: Verruca is a common infection globally, but rarely presents in the esophagus. Prior to diagnosis of a benign esophageal verruca; squamous cell carcinoma, verrucous carcinoma and hyperkeratosis should be ruled out. Endoscopically these conditions may look very similar, thus it is crucial to histologically differentiate as the clinical course may differ greatly. Even though squamous papillomas have been thought to be benign lesions, there has been some data to suggest possible malignant transformation. Proper diagnosis will facilitate proper management and treatment options.
Figure: Esophageal mass with pathology
Disclosures: Emmanuel McDonald indicated no relevant financial relationships. Zaid Rana indicated no relevant financial relationships. Paul Khoury indicated no relevant financial relationships. Amir Riaz indicated no relevant financial relationships. Mark Avila indicated no relevant financial relationships. Karthik Mohan indicated no relevant financial relationships.
Emmanuel A. McDonald, DO1, Zaid Rana, DO, MPH2, Paul Khoury, 3, Amir Riaz, MD4, Mark Avila, MD, MBA5, Karthik Mohan, DO1. P1389 - A MASS-ive Esophageal Wart, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.