A 44-year-old woman visited the outpatient clinic with reports of EGD examination showing a GEJ polyp. EGD had been performed as part of a health promotion screening, and the patient denied having any subjective symptom or past medical history including smoking and alcohol consumption. She looked generally healthy. Physical examination and laboratory test revealed that all values were within the normal reference range.\nEGD examination revealed that the polyp was located just on the squamocolumnar junction of the GEJ and presented as a 1.5-cm protruding polypoid mass with an irregular and nodular surface (). Forceps biopsy was performed to exclude malignant tumor. Microscopic examination revealed squamous papilloma showing papillary squamous epithelium with a fibrovascular core. Squamous epithelial cells of the papilloma showed koilocytosis with irregular nuclear membrane and perinuclear halo, which histologically confirmed the presence of human papillomavirus infection ().\nAfter obtaining informed consent from the patient, endoscopic mucosal resection was performed to remove the whole papilloma at the GEJ to avoid a possible increase in the size of the tumor. Histological examination of the resected specimen revealed a nodular mass with papillary growth consisting of squamous cell epithelium with a well-structured inner fibrovascular core, which was compatible with squamous papilloma. The specimen showed complete and curative resection, without involvement of the lateral or vertical margin.\nTwo years later, the patient revisited our clinic for esophageal reflux symptoms. Follow-up EGD incidentally revealed a polyp at the GEJ at the exact spot of the previously removed papilloma. The polyp measured approximately 1.0 cm and had a morphology similar to that of the previous papilloma (), suggesting recurrence. Although the polyp was smaller than that detected 2 years previously, endoscopic submucosal dissection was performed owing to fibrotic scarring and non-lifting sign at the anal side of the polyp (). The polyp was removed en bloc and completely, without marginal involvement. Microscopic examination revealed nodular mass with papillary growth. Histologic examination revealed usual papilloma showing papillary squamous epithelium, with a well-developed fibrovascular core. However, multifocal severe squamous atypia was observed throughout the mucosal epithelium, compatible with squamous cell carcinoma in situ (). The patient was finally diagnosed with squamous cell carcinoma in situ arising from esophageal squamous papilloma.
A 61-year-old female with history of uncontrolled diabetes mellitus type 2 complicated by gastroparesis, prior esophageal dilation, and ileostomy was being evaluated with endoscopy as outpatient for worsening dysphagia. EGD was significant for a small nodule in the proximal esophagus (see ), normal GEJ (gastroesophageal junction), mild gastritis, and normal duodenum. Gastric biopsy demonstrated mild chronic gastritis without dysplastic changes or Helicobacter pylori. Esophageal biopsy demonstrated findings consistent with squamous papilloma.