Esophageal papilloma is a rare endoscopic finding. Lesions are usually less than 5 mm, appear as a solitary sessile nodule, and are located in the middle or upper part of the esophagus. The surface has a warty-like structure. Malignant potential of esophageal papilloma is unknown. The essential differential diagnosis of esophageal papilloma comprises squamous cell, verrucous carcinoma, and hyperkeratotic lesions. Owing to missing data there are no therapeutical recommendations. In a pragmatic approach, lesions should be removed endoscopically. The underlying etiology remains unclear. Infection with human papilloma virus (HPV) has been described, but more than 50% of esophageal papillomas have tested HPV negative. However, it should be kept in mind that HPV testing has a gray zone due to the fact that it does not test for all of the more than 60 existing HPV subtypes. Mucosal damage caused by gastroesophageal reflux have been implicated as a second risk factor for esophageal papilloma in the distal esophagus. Malignant potential of esophageal papilloma is unknown, whereas squamous papillomas of the oral cavity or oropharynx and anogenital lesions are defined as premalignancies. There are few individual case reports describing a malignant transformation of esophageal papillomatosis. This entity has a different phenotype compared to esophageal papilloma; one finds there a superficial, circumferential, rather than a nodulelike growth pattern. Differential diagnosis of esophageal papilloma should comprise squamous cell, verrucous carcinoma, and hyperkeratotic lesions. As a rare differential diagnosis, an inflammatory fibroid polyp (composed of inflammatory cells including eosinophils and fibroblastic tissue) should be considered. Owing to missing data, there are no therapeutical recommendations. In a pragmatic approach, lesions should be removed endoscopically. If the histology shows a papilloma, no further diagnostic or therapeutic steps are necessary. Recurrence is uncommon.

• published: 15 Jan 2014
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