Sistema gastrointestinal y digestivo

Abstracto

Total Esophagectomy and Endoscopic Radiofrequency Ablation for a Case of Diffuse Esophageal Papillomatosis: Case Report

Angela Romano, Michele Grassia, Giuseppe Esposito, Marianna Petrillo, Modestino Pezzella, Francesco Maria Romano, Francesco Torelli, Antonio Volpicelli, Franca Ferraraccio, Gerardo Nardone, Natale di Martino

Esophageal squamous papilloma (ESP) is a benign epithelial lesion. ESP is extremely rare and it has been described in few cases in literature. The etiology of ESP may be associated to chronic mucosal irritation and HPV infection. It is usually asymptomatic and mostly discovered as an incidental finding during upper gastrointestinal endoscopy. It is considered a benign neoplasia but recent reports have stressed the potential malignant evolution of these lesions. A 53 year old caucasian woman presented with a four years history of disphagia not responsive to medical therapy. At upper endoscopy, esophageal mucosa appeared hyperemic and completely covered by numerous (>100) sessile peduncolate papules. Biopsies demostrating atypical epithelial proliferation confirmed the diagnosis of esophageal squamal papillomatosis with low grade and focal high grade dysplasia; in situ hybridization studies for HPV were perfomed and it was positive for the type 16. We report a case of diffuse esophageal papillomatosis with histologic and microbiologic findings of genotype 16 HPV and Lichen Planus infection successfully treated with an Ivor Lewis Esophagectomy and a second look endoscopy by radiofrequency ablation.