S1075 Prevalence, Characteristics, and HPV Testing Outcomes of Esophageal Squamous Papillomas: A Retrospective Study of the Largest Single-Center Cohort

Introduction: Esophageal squamous papillomas (ESPs) are rare, benign tumors typically detected incidentally on endoscopy. While their incidence has risen, their pathogenesis and malignant potential remain unclear. ESPs have been associated with chronic mucosal irritation and human papillomavirus (HPV) infection, but reported HPV detection rates vary widely (0-85.7%) due to small sample sizes and inconsistent testing methods, many of which do not assess oncogenic HPV activity. A better understanding of ESPs is needed to guide management. We present the largest study to date evaluating the clinical characteristics of ESPs and the utility of HPV testing, including ribonucleic acid (RNA)-based assays, at a tertiary academic center. Methods: Single-center retrospective cohort study of patients with ESPs was performed. All patients, age >18 years, presenting between January 2018 and July 2023, diagnosed with ESPs and sufficient tissue samples were included. Slides were reviewed by pathologists. RNA-based chromogenic in situ hybridization (ISH) studies for low- and high-risk HPV subtypes were performed. Extensive chart review for demographic information, clinical history (including tobacco use, alcohol consumption, and prior gastrointestinal malignancy), and HPV vaccination status were recorded. Results: Of the total 184 ESP cases, none demonstrated squamous dysplasia or invasive carcinoma (0%). All samples were negative for low- and high-risk HPV on RNA-based testing. The cohort was predominantly women at 66%, median age of 53 years (range 19-87 years), and 89% White, non-Hispanic. Tobacco and chronic alcohol use were reported in 31% and 23%, respectively. Endoscopically, 98% lesions appeared as nodules or polyps. Nearly all lesions measured under 1 cm (98%). Lesions were most commonly in the mid-esophagus (46%), followed by distal (32%), and proximal (22%). Forty percent underwent complete excision and 58% tissue sampling. Thirty-three had a repeat esophagogastroduodenoscopy, of those 2% had ESP recurrence. Conclusion: This study represents the largest single-center review of esophageal squamous papillomas to date, no cases of dysplasia or carcinoma were identified, and all specimens tested negative for oncogenically active low/high-risk HPV using highly sensitive RNA ISH, suggesting that ESPs are not precursor lesions to squamous cell carcinoma and their pathogenesis is unrelated to an HPV infection. Further studies are needed to determine standardized management guidelines regarding ESPs. Our data support that endoscopic excision is typically curative for these incidental squamous proliferations.