Esophageal Squamous Papilloma in the Practice of Otolaryngology: A Case Series and Diagnostic Considerations for the otolaryngologist

BACKGROUND: Esophageal squamous papilloma (ESP) is a rare, benign, often asymptomatic lesion of the upper aerodigestive tract. While historically managed by gastroenterologists, transnasal esophagoscopy has been incorporated into some otolaryngology practices, expanding the role of the otolaryngologist in diagnosing these lesions. AIMS: To describe a case series of ESP within a tertiary dysphagia center and evaluate the association between human papillomavirus (HPV) and chronic mucosal irritation. METHODS: A retrospective case series was conducted of all individuals diagnosed with ESP at a tertiary center over a 2-year period. Histopathology and DNA in-situ hybridization (ISH) for high and low-risk HPV were reviewed. RESULTS: Five cases were identified. All patients presented with dysphagia or heartburn. ESP was an incidental finding in all cases, co-existing with cricopharyngeal dysfunction, hiatal hernia, or esophagitis. One patient had a history of HPV+ oropharyngeal carcinoma. All lesions were successfully resected endoscopically. ISH was negative for HPV in all specimens. CONCLUSIONS AND SIGNIFICANCE: ESP is a benign entity frequently encountered incidentally during the workup of dysphagia. These results support chronic irritation rather than HPV as the primary etiology. Recognition is vital for otolaryngologists to ensure appropriate resection and surveillance.