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Video Endoscopic Sequence 1 of 9.
Large Esophageal Papilloma
This a 27 year old-male, This lesion was diagnosed on routine endoscopy
For further endoscopic information, download the video clip by clicking on the endoscopic image. Wait to be downloaded complete then Press Alt and Enter for ful screen ( Windows Media), Real Player: Ctrl and 3.All endoscopic images shown in this Atlas contain video clips. We recommend seeing the video clips in full screen mode.
The role of the human papilloma virus in esophageal
cancer.
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Video Endoscopic Sequence 2 of 9.
Endoscopic Imaging of a Large Esophageal Papilloma
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.
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Video Endoscopic Sequence 3 of 9.
Image and Video Clip of a Large Esophageal Papilloma
Esophageal papilloma is a rare endoscopic finding with prevalence under 0.3%, without a predilection for gender. These benign tumors are usually less than 5 mm and appear as a solitary sessile nodule with a warty-like surface. However, very rarely they may also appear as large areas with irregular surface, as shown in the video demonstration. Most papillomas are located in the middle or upper part of the esophagus. They do generally not cause clinical symptoms.
Malignant potential of esophageal papilloma is unknown, whereas squamous papillomas of the oral cavity or oropharynx and anogenital lesions are defined as premalignancies.
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Video Endoscopic Sequence 4 of 9.
Image and Video Clip of a Large Esophageal Papilloma
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.3 Mucosal damage caused by gastroesophageal reflux have been implicated as a second risk factor for esophageal papilloma in the distal esophagus.
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.
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SVideo Endoscopic Sequence 5 of 9.
Endoscopy a Large Esophageal Papilloma
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.
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Video Endoscopic Sequence 6 of 9.
Endoscopy a Large Esophageal Papilloma
Some biopsies are obtained and the tissue is debrided
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.
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Video Endoscopic Sequence 7 of 9.
The partially debrided Papilloma with the forceps
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Video Endoscopic Sequence 8 of 9.
It proceed to remove the rest with ablative therapy using argon plasma coagulator (APC)
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Video Endoscopic Sequence 9 of 9.
Final State of ablative therapy of Esophageal papilloma using Argon Plasma Coaugulation
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Video Endoscopic Sequence 1 of 4.
Esophageal Papilloma of the Lower Third.
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Video Endoscopic Sequence 2 of 4.
Esophageal Papilloma of the Lower Third.
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Video Endoscopic Sequence 3 of 4.
Esophageal Papilloma of the Lower Third.
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Video Endoscopic Sequence 4 of 4.
Esophageal Papilloma of the Lower Third.
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Video Endoscopic Sequence 1 of 3.
Papilloma of the upper third of the Esophagus immediately under the sphincter.
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Video Endoscopic Sequence 2 of 3.
Papilloma of the upper third of the Esophagus immediately under the sphincter.
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Video Endoscopic Sequence 3 of 3.
Papilloma of the upper third of the Esophagus immediately under the sphincter.
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Video Endoscopic Sequence 1 of 4.
Endoscopic Image of Esophageal Papilloma
Most are asymptomatic, although they may cause dysphagia. The most frequent location is the posterior wall of the lower third of the esophagus, and the lesions are usually isolated. Endoscopically, the papilloma is a warty, polypoid mass that is firm to touch.
There are no pathognomonic symptoms for the typica esophageal squamous papilloma, unless the patient presents with the rare large papilloma or diffuse esophageal papillomatosis which may cause dysphagia.
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Video Endoscopic Sequence 2 of 4.
Endoscopic Image of Esophageal Papilloma
Esophageal papilloma, an infrequent benign tumor, and esophageal squamous-cell carcinoma sometimes appear to be associated with human papillomavirus (HPV) infection, HPV being implicated in anogenital carcinogenesis. Human papillomavirus (HPV) has been implicated as a causative agent in a variety of human squamous cell carcinomas, including those of the skin, cervix, anogenital region, upper respiratory tract, and digestive track.
To date, more than 70 different HPV types have been identified; some of which are frequently associated with cancers and are considered high risk HPVs(types 16 and 18), whereas others give rise to warts and benign lesions and are considered low risk (types 6, 11, and 33).
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Video Endoscopic Sequence 3 of 4.
Histologically in papillomas, mature squamous epithelium is arranged along a branched fibrovascular stalk with an exophytic, endophytic, or spiked architectural pattern
Esophageal squamous papillomas are rare, benign, tumors of an epithelial origin.
Histological findings of esophageal squamous papilloma.
Representative histological features of ESP.
Shows a papillary projection lined with acanthotic
epithelium
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Video Endoscopic Sequence 4 of 4.
Increased squamous hyperplasia with a fibrovascular core.
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Video Endoscopic Sequence 1 of 3.
Esophageal Papilloma with Jaundice
A 40-year-old male presents with generalized jaundice due to liver cirrhosis, has esophageal varices and a papilloma which has acquired icteric dye.
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Video Endoscopic Sequence 2 of 3.
Esophgeal Papilloma stained of a icteric dye
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Video Endoscopic Sequence 3 of 3..
Esophageal varices with the icteric papilloma are displayed
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Esophageal Papilloma
Papilloma of the middle third of the esophagus.
Esophageal squamous papilloma (ESP) is a relatively rare,
benign, squamous epithelial tumor, which is generally small,
single, round and elevated sessile lesions with smooth or
rough surfaces. Two etiological factors of ESPs have been
posited. One is hyper-regenerative response of the mucosa
to chemical and mechanical irritation such as minor trauma,
chronic food impaction, alcohol consumption, cigarette
smoking, previous gastroesophageal surgery and
gastroesophageal reflux diseases (GERDs). The mucosal
irritant theory is clinically supported by the high prevalence
of ESPs in the lower esophagus, the site most severely
affected by GERDs. The other is human papilloma virus
(HPV) infection. Since Syrjanen et al. demonstrated the
presence of HPV antigens in ESPs, HPV infection
has been considered one of the etiological factors of ESPs,
although the exact pathogenetic importance of the HPV is
not yet clear.
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Esophageal Papilloma
Esophageal squamous papillomas are usually a single,
round, elevated, sessile formation, well delineated from the
surrounding tissue. They range in size from 2mm up to 2cm
X 5cm, but average about 5-6mm. They tend to be
whitish/pink and have a soft consistency.
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Video Endoscopic Sequence 1 of 3.
Esophageal Papilloma of the Lower Third.
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Video Endoscopic Sequence 2 of 3.
Video Clip of Esophageal Papilloma of the Lower Third.
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Video Endoscopic Sequence 3 of 3.
Endoscopic Image of Esophageal Papilloma of the Lower Third
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Video Endoscopic Sequence 1 of 3.
Papilloma of the Esophagus with blood traces.
This is a 58 year-old male who suffered an upper
gastrointestinal bleeding due to a gastric varix.
Incidental finding shows a papilloma with hematic rest.
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Video Endoscopic Sequence 2 of 3.
Another image and video clip of a papilloma with traces of blood
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Video Endoscopic Sequence 3 of 3.
It proceed to eliminate with cautery and APC.
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Video Endoscopic Sequence 1 of 2.
Papilloma of Oropharynx
In this image as well as in the video clip, there is a lesion
corresponding to a papilloma which is immediately after
upper esophageal sphincter.
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Video Endoscopic Sequence 2 de 2.
Infection with human papillomavirus (HPV).
It is associated with oral and oropharyngeal cancer.
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Secuencia Video Endoscópica 1 de 3.
Papilloma anterior to the oropharynx
A 42-year-old male at a routine endoscopy finds this lesion near the oropharynx.
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Secuencia Video Endoscópica 2 de 3.
Another image and video of oropharyngeal papilloma
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Secuencia Video Endoscópica 3 de 3.
Some biopsies are obtained which reveal to be a papilloma.
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Video Endoscopic Sequence 1 of 3.
Papilloma of the tongue
A 93-year-old male in an upper endoscopy found this papilloma of the tongue, as well as a presbyophagous and acute duodenitis.
Common intraoral benign epithelial neoplasm
Mean age 38 years
50% associated with human papillomavirus (HPV 6 and 11); others may represent reactive epithelial hyperplasia
Sites: posterior hard palate, soft palate and uvula (34%), dorsum and lateral tongue borders (24%), gingiva (12%), lower lip (12%) and buccal mucosa (6%)
Treatment
Excision; 4% recur.
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Video Endoscopic Sequence 2 of 3.
Papilloma of the tongue
Genital infection by human papillomavirus (HPV), a sexually transmitted disease (STD), has increased considerably due to the changes in sexual behaviour and an increase in the practice of oral sex. HPV, in a parallel manner, has been closely studied due to its oncogenic potential. We present the case of a 27-year-old patient, with a multi-partner sexual history and frequent practice of oral sex, who suffered from warts lesions on the genitalia and tongue. Squamous papilloma was diagnosed from a tongue biopsy. The treatment of the oral lesion was by way of surgery, without relapse in the first two years. Our discussion in this report is regarding the HPV infection in the oral cavity.
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Video Endoscopic Sequence 3 of 3.
Papilloma of the tongue
Human papillomavirus (HPV) is a DNA virus that belongs to the papilomaviridae family, frequently sexually transmitted, causing infections which have an incubation period varying from three weeks to an indeterminate length of time and are prevalent in women
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