Esophageal papilloma

Introduction to esophageal papilloma Esophageal papilloma (EP) is a polypoid tumor of benign squamous epithelium. In the past, EP has been considered to be rare, often because of accidental findings in other upper gastrointestinal symptoms for endoscopy. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal cancer

Esophageal papilloma etiology

(1) Causes of the disease

The etiology of EP is unknown, and its pathogenesis is also controversial. It is currently considered to be related to the following factors:

1. Mucosal injury Gastroesophageal reflux, esophagitis, hiatal hernia, mechanical operation, etc. often cause EP, Carr et al reported two cases of previous biopsy confirmed esophagitis, EP found in the follow-up, EP in the distal 1/3 of the esophagus More common, here are the most severely affected by these lesions, endoscopic examination of the damage, chronic esophageal foreign body impaction, repeated use of the probe to expand the narrow esophagus and surgical trauma have caused EP reports, many EP pathological examination There is evidence of inflammation.

2. Human papillomavirus (HPV) infection: HPV has high affinity with human squamous epithelium. Some people have found immunohistochemical evidence of HPV infection in hyperplastic esophageal mucosa. Some people think that hollow cells are diagnosed. A histological indication of HPV infection, however, the HPV detection rate of each EP is very inconsistent, and even the authors report that HPV is negative, so the exact relationship between HPV and EP remains to be further studied.

3. The role of tumor-causing substances: Animal experiments have found that oral special chemicals such as N-ethyl-N-nitrosoguanidine can cause EP, and rats are fed with foods that are separated from each other. The bacteria have selective tumorigenic effects on the squamous epithelium of the rat's anterior stomach and esophagus. The lesions include gastric papilloma (25.6%), anterior papillary carcinoma (2.6%) and papillary hyperplasia of the esophagus and papilloma. (5.1%), when studying the combination of vitamin A, vitamin E and vitamin C to prevent Bap-induced lung cancer in rats, it was unexpectedly found that most of the rats in the prevention group developed papillary epithelial papillary hyperplasia, and the incidence rate was male. 68.7%, female rats were 91.3%. The lesions occurred in the upper and middle segments of the esophagus. No dysplasia occurred. Why did the Bap group, the vitamin group, and the normal group have no such phenomenon, and only a high incidence occurred in the Bap plus vitamin group. Esophageal papilloma-like hyperplasia? Description of the synergy of a variety of substances can cause tumorigenicity.

4. Genetic factors: Some people think that EP is related to genetic factors, such as congenital skin disease, Goltze syndrome can be associated with EP, patients with abnormal karyotype and O-raf-1 gene deletion have multiple polyps of the gastrointestinal tract , including EP.

5. Results of multiple factors: At present, most people believe that EP is the result of multiple factors, that is, the presence of harmful chemicals and chronic stimuli add or activate HPV infection, and HPV can also be caused by other factors such as mucous membrane stimulation. The aggravation of the lesions, the synergy between the two, this view is accepted by most people, but the exact pathogenesis remains to be further studied.

(two) pathogenesis

Esophageal papilloma is a benign unsuperficial tumor, mainly from the esophageal mucosa, formed by proliferating epithelial cells, containing connective tissue and blood vessels, which are scorpion-like, nodular, cauliflower-like bulge, with a diameter of 2 to 10 cm. There are also reports of 5 to 6 cm.

1. Characteristics of histology: Esophageal papilloma can be divided into three types according to growth mode:

(1) Exogenous type: smooth finger or dendritic appearance, the squamous epithelium of the surface layer is papillary hyperplasia, the epithelial differentiation is mature, the central axis of the nipple is the central axis composed of fibrovascular, and some epithelial incomplete keratinization, nearly 2 There was significant inflammatory cell infiltration in the interstitial of /3 cases.

(2) Endogenous type: The shape is smooth and rounded. Under the microscope, the epidermis is inverted, accompanied by squamous epithelial incomplete keratinization, acanthosis, some hollow cells in the epithelium, interstitial Inflammatory cells infiltrate.

(3) Peak shape: the shape is a peak-shaped protrusion. Under the microscope, the epidermis is hyperplastic, the epithelial granule layer is prominent, and the keratinization or incomplete keratinization is obvious. Among the above three types, the exogenous type is the most, and the endogenous type is the most. The peak type is rare.

Characteristics of HPV-positive EP: more exogenous types, fewer endogenous and peak types, more incidence of knockout cells, but no statistical significance, acanthosis and a large number of knockout cells may indicate HPV infection, but It is not expected that it must contain HPV DNA, indicating that the characteristics of histology have a limited role in the diagnosis of HPV infection.

2. Problems related to esophageal cancer in EP: Whether EP will be malignant This is an important and controversial issue. The following points make people think that EP is related to esophageal cancer.

(1) Evidence that EP shows intercellular and cancerous changes: Squamous papilloma of the larynx and genital tract has been associated with squamous cell carcinoma.

(2) Evidence of HPV DNA: HPV 6, 11, 16, and 18 have been widely associated with different types of cancer, and evidence of HPV DNA has also been found in esophageal and esophageal cancer.

(3) Animal experiments confirmed that bovine papillomavirus induced EP and malignant transformation, and that the anterior gastric and esophageal papilloma can be induced in the rat, and the anterior gastric papillary carcinoma can also be induced, but recently At follow-up, there were no cases of malignant transformation in several large reports.

Esophageal papilloma prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Esophageal papilloma complications Complications Esophageal cancer

Patients with EP are likely to have oral and respiratory tumors in the presence of mucosal irritation, so patients with EP should be examined and followed up for tumors in adjacent organs. Severe possible esophageal cancer.

Esophageal papilloma symptoms Common symptoms Heartburn, sternal pain, blood in the throat

The age of onset is mostly in middle-aged and old age. The onset is insidious, and the clinical manifestations are non-specific. Most of the above abdominal symptoms, such as sternal pain, difficulty in swallowing, heartburn, etc., have blood in the stool, iron deficiency anemia, vomiting as the main symptom. Less, patients often accidentally discovered by gastroscopy for stomach diseases, the disease is easy to merge with other sites of the tumor, Carr et al reported that 6 of the 25 cases of EP showed malignant tumors in other parts, 4 of which were throat and lungs The cancer is the other, skin cancer and bladder cancer.

Examination of esophageal papilloma

Some EP forms can be misdiagnosed as acanthosis or squamous cell carcinoma, which needs to be identified by histology. Therefore, biopsy is recommended for EP.

X-ray combined with endoscopic biopsy can confirm the diagnosis. Most of the EP under the endoscope has a spherical or hemispherical bulge, mostly without pedicle, light pink, soft and elastic, and the size is about 0.4-0.6cm. Rarely more than 1cm, mostly single, often located in the lower part of the esophagus, if you see the above performance under endoscopy, you should be highly suspected of this disease, a small number of EP is flat, bulging, white, or red due to congestion, erosion, and HPV-related The EP is more common in the upper part of the esophagus and is multifocal.

Diagnosis and diagnosis of esophageal papilloma

diagnosis

The diagnosis of esophageal papilloma mainly through X-ray barium meal and esophagoscopy, X-ray examination combined with endoscopic biopsy can confirm the diagnosis.

1. Clinical manifestations.

2. Laboratory and other auxiliary inspections.

Differential diagnosis

Some of the gross morphology of esophageal papilloma can be misdiagnosed as ecdysis or squamous cell carcinoma, which needs to be identified by histology. Therefore, biopsy is recommended for EP.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.