A 38-year-old female patient presented to our fast-track ENT clinic with persistent left-sided throat discomfort and pain for several months. The throat pain lateralised to the left and radiated to her left ear. She also reported positive reflux symptoms with heartburn. At the time of review, medical management had been implemented (with high-dose oral proton pump inhibitor and raft-forming alginate); however, this yielded no symptomatic relief. Voice Handicap Index (VHI) was 11 and Eating Assessment Tool (EAT-10) score was 1. She was a non-smoker, and her past medical history was insignificant.\nOffice examination of the neck, oral cavity and oropharynx was unremarkable. Flexible nasendoscopy was performed, which revealed some post-cricoid oedema consistent with laryngopharyngeal reflux (Figure ). A contrast-enhanced magnetic resonance imaging (MRI) scan of the neck was normal. As symptoms continued to persist, a transnasal oesophagoscopy (TNO) under local anaesthetic was performed as an office procedure where a proximal oesophageal lesion was identified (Figure ). The lesion appeared small (approximately 3 mm in diameter), exophytic, non-ulcerating and papillomatous. It was located on the left side of the upper oesophageal mucosa, 23 cm from the nasal sill. Multiple punch biopsies were taken.\nHistological examination of the specimen revealed squamous cell papilloma of benign appearance with prominent papillae and acanthotic stratified squamous epithelium without cellular atypia. The specimen tested positive for human papilloma virus (HPV). Oesophageal manometry and 24-hour oesophageal pH monitoring indicated borderline pathological reflux with some proximal penetration (DeMeester score [DMS] = 15.9).\nThe patient then underwent complete endoscopic excision of the lesion. Histology confirmed HPV-positive squamous papilloma. Anti-reflux treatment, including lifestyle changes, was continued. Following excision, the patient’s symptoms resolved and a yearly follow-up confirmed their complete remission. It is yet uncertain whether symptomatic relief was a result of excision, continued anti-reflux treatment, or even a placebo effect associating the procedure.
A 53-year-old male with history of alcohol abuse presented with new-onset seizure/syncope, six painless maroon stools, and coffee-ground emesis. The patient admitted to frequent diclofenac use and ketorolac injections. He did not have a history of varices. Vital signs demonstrated tachycardia (heart rate 111 beats/min) and hypotension (79/59 mmHg). Physical exam revealed pale conjunctiva, dry mucous membranes, and maroon colored stool. He was found to be anemic with a hemoglobin of 7.9 G/dL and had an elevated INR of 1.2. He was transfused two units of packed red blood cells and was started on a pantoprazole drip.\nOnce stabilized, initial EGD revealed an island of tissue growth in the mid-esophagus and a bleeding duodenal ulcer that was injected with epinephrine, cauterized with gold probe and clipped. Biopsy of the esophageal lesion was deferred to outpatient follow-up given the severity of the patient's presenting condition. He had no further signs of gastrointestinal bleeding. Two weeks later, a repeat EGD was performed. Biopsies were taken of the stomach mucosa and mid-esophageal mass (see ). Gastric biopsy demonstrated mild chronic gastritis without dysplastic changes or Helicobacter pylori. Esophageal biopsy demonstrated findings consistent with squamous papilloma (see Figures and ).