Verrucous Carcinoma of the Esophagus: Its Unique Etiology and Association with Human Papilloma Virus

Abstract

Verrucous carcinoma of the esophagus (VCE) is a rare variant of esophageal squamous cell carcinoma. Most cases of VCE presents as an exophytic, slow-growing mass with a superficial growth pattern. Even when VCE exhibits a characteristic pattern during an endoscopic examination, it is very difficult to make a definitive diagnosis of VCE preoperatively, because biopsy specimens are only characterized by nonspecific acanthosis and hyperkeratosis or parakeratosis associated with inflammation. As well as the characteristics of VCE, the etiology of the disease is even unique. VCE is typically associated with chronic mucosal irritation such as reflux esophagitis, achalasia, and lye ingestion that has resulted in esophageal inflammation or a long-term local disease process in addition to the classic risk factors of nicotine and alcohol consumption. Recent studies had indicated that human papilloma virus (HPV) infection might be associated with VCE. While HPV may be related to VCE initiation, involvement of HPV in the etiology of VCE requires further investigation. VCE's etiology and therapeutic strategy, including the vaccination against HPV, should be established.