ESOPHAGEAL SQUAMOUS PAPILLOMAS - A CLINICOPATHOLOGICAL STUDY OF 38 LESIONS AND ANALYSIS FOR HUMAN PAPILLOMAVIRUS BY THE POLYMERASE CHAIN-REACTION

The pathogenesis of esophageal squamous papilloma is not known, but ch ronic mucosal irritation and infection with human papillomavirus are t wo proposed etiologies. To investigate these hypotheses, we analyzed t he clinical data and histological features of 38 esophageal squamous p apillomas from 33 patients and performed the polymerase chain reaction technique for detection of several common human papilloma virus types on a subset of cases (n = 26) with sufficient available material. Cli nically, males were affected more often than females (M:F ratio = 24:9 ); average age was 50 (range, 2-86 years). Most papillomas occurred si ngly (85%) and were located in the distal esophagus (70%). Patients wi th esophageal squamous papillomas, especially those with lesions in th e distal esophagus, commonly had an associated chronic and often sever e form of esophageal mucosal irritation such as esophagitis or Barrett 's esophagus. Esophageal squamous papillomas were small polyps (averag e size, 0.5 cm) that we classified histologically into three types (ex ophytic, 50%; endophytic, 37%; spiked, 13%) based on the predominant s hape of the squamous papillae. Fifty percent of the papillomas (13 of 26) tested, from 57% of patients (12 of 21), were positive for human p apilloma virus, most commonly type 16 (nine of 13), less often type 16 and 18 together (3/13), and rarely type 6b/11 (1 of 13). We propose a multifactorial etiology in which the synergistic action of mucosal ir ritation and human papilloma virus may be necessary for the developmen t of esophageal squamous papillomas.