Combined Extensive Esophageal Squamous Papillomas and Florid Cardiac Gland Hyperplasia in a Patient with Adenocarcinoma

Abstract

We report a rare case of extensive esophageal squamous papillomas (ESPs) involving the entire esophagus and florid cardiac gland hyperplasia involving only the lower esophagus in a 39-year-old woman with heartburn and epigastric distress for the past 2 years. Previous esophagogastroduodenoscopy showed multiple ESPs involving the entire esophagus extending 38 cm from the esophageal orifice to the esophagogastric junction (EGJ). Additionally, prominent cardiac gland hyperplasia over the esophageal posterior wall was exhibited extending 12 cm from the mid-esophagus to the EGJ. A biopsy obtained from the ESP area showed typical squamous papillomas and cardiac gland hyperplasia with no evidence of koilocytosis or malignancy. Polymerase chain reaction was negative for a variety of human papilloma virus DNAs. Subsequently, Siewert type II gastric cancer with submucosal elevation of the stomach was detected at the EGJ. Endoscopy showed a 20-mm-thick lesion appearing to extend to the muscularis propria; subsequent biopsy showed invasive adenocarcinoma. Total gastrectomy with D2 lymph node dissection, splenectomy, and Roux-en-Y reconstruction were performed for the EGJ cancer. The patient died from widespread multiorgan metastasis within 2 years following surgery.

Esophageal papillomatosis: an exceedingly rare disease

“…Interestingly, some patients acquired EPS, 1–3 year after esophageal carcinoma esophagectomy and gastric carcinoma surgery [ 17 , 49 , 58 , 61 ], in which gastroesophageal reflux may play an important role during the process. Other EPS cases can also be found to be associated with oropharyngeal cancer and gastric adenocarcinoma [ 27 , 62 , 63 ], for which there are no suitable explanations. Thus, the cause of the malignant transformation is unclear and controversial; however, the malignant potential of EPS cannot be ignored.…”