A 67-year-old Caucasian man visited his primary care physician with complaints of hematemesis and continuous dysphagia. He had history of cigarette smoking and social alcohol consumption. Previous medical history included hypertension and hyperlipidemia. An initial EGD showed multiple verrucous lesions extending from 30 cm to 39 cm from his incisors. Pathological examination of the multiple biopsies showed squamous papillomatosis.\nThe patient was referred for evaluation at our hospital and a new EGD showed the same extensive verrucous lesions with three large growths on the distal esophagus causing significant stenosis. He repeated the biopsies and maintained the previous histological diagnosis. A thoracoabdominal CT-Scan revealed large esophageal lesions apparently superficial with thickening of the esophageal wall. Endoscopic Ultrasound showed that these changes were almost all limited to the mucosa and submucosa except in one area where they appeared to penetrate deeper.\nAt this time, the patient’s dysphagia got worse and there was substantial suspicion of potential malignancy. After a multidisciplinary discussion, he was proposed for surgery. He underwent a minimally invasive Ivor-Lewis Esophagectomy (laparoscopy + right lateral thoracoscopy) with a mechanical termino-lateral esophago-gastric upper thoracic anastomosis (at approximately 24/25 cm from the incisors) (Figs. , ). The postoperative (PO) period was uneventful and the patient was discharged at the 9th PO day.\nThe examination of esophagectomy specimen () showed a squamous cell carcinoma in situ (verrucous type) of the distal esophagus with areas of high dysplasia and extensive diffuse squamous papillomatosis. There were no signs of lymphatic or perineural invasion and margins were clear. The eighteen lymph nodes excised were all negative for malignancy. The TNM stage (8th edition) was Tis N0. One year later, at the follow-up consultation, there were no signs of recurrence.
A 54-year-old female with history of fibromyalgia, chronic opioid dependency, cyanocobalamin deficiency, vitamin D deficiency, and GERD with previously noted Los Angeles class C esophagitis was being evaluated with endoscopy as outpatient for dysphagia and abdominal pain. EGD was significant for an exophytic wart-like growth in the distal esophagus, minimally irregular Z-line noted at GEJ, mild gastritis without ulcers, and normal duodenum. GEJ biopsy demonstrated focal intestinal metaplasia suggestive of Barrett's esophagus without dysplastic changes. Esophageal biopsy demonstrated findings consistent with squamous papilloma (see Figures and ).