Esophageal papilloma (hereinafter referred to as EP) is a rare benign tumor of esophagus, also known as esophageal squamous cell papilloma and esophageal squamous epithelial papilloma. 65438-0959, Adler et al. confirmed the existence of human esophageal papilloma for the first time through pathology. EP can occur in the middle and lower esophagus, mostly with small polypoid protuberance. Histologically, it is characterized by stratified squamous epithelial hyperplasia with fibrovascular axis. Due to the relative increase of EP reports in recent years, the author made a rough statistics. From 2000 to 20 16, there were nearly 8,000 papers on EP in Wan Fang data alone, and the controversial focus was on the research on the relationship between EP and the incidence of esophageal cancer caused by human papillomavirus infection (Syrjanen et al. first discovered in 1982 that human papillomavirus infection in esophagus may be related to the incidence of esophageal cancer). 2.2. Research on the relationship. EP and human papillomavirus infection; Among them, there are many research articles about esophageal cancer and human papillomavirus infection in Kazak nationality in Xinjiang. The author also pays attention to whether the esophageal papilloma induced by human papillomavirus is contagious, whether antiviral treatment is needed, and the comparison of long-term follow-up results of EP at home and abroad. In order to enable patients and ordinary people to correctly understand esophageal papilloma, the author makes the following simple summary.

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Etiology: The etiology of esophageal papilloma (EP) is unknown, which may be related to the following factors:

1 Mucosal injury:

Chemical factors:

(1) Gastric acid: EP caused by gastroesophageal reflux has been supported clinically, because most EP in the lower esophagus of 1/3 is accompanied by gastric acid reflux. Patients with hiatal hernia and gastroesophageal surgery are prone to gastroesophageal reflux disease. Gastroscopy often finds EP in the lower esophagus due to gastric acid reflux and heartburn symptoms.

(2) Smoking and drinking: Smoking and drinking can directly stimulate the esophageal mucosa, and can also aggravate gastroesophageal reflux, which will cause chronic irritation to the esophageal mucosa.

Mechanical operation: injury caused by endoscopy, chronic esophageal foreign body impaction, repeated use of bougie to dilate narrow esophagus, esophageal stent, varicose vein sclerosis treatment, nasogastric tube insertion, etc. Can cause EP.

Inflammatory stimulation caused by mucosal injury is considered to be the main factor causing EP, and many pathological examinations of esophageal papilloma have evidence of inflammation.

2. Genetic factors

Some people think that esophageal papilloma is related to genetic factors, such as congenital dermatosis and Gohze syndrome. Patients with abnormal chromosome karyotype and O-raf- 1 gene deletion may have multiple polyps in gastrointestinal tract, including esophageal papilloma.

3. The result of multiple factors * * *

At present, most people think that esophageal papilloma is the result of many factors, that is, the existence of harmful chemicals and chronic stimulation, coupled with human papillomavirus infection, the two play a synergistic role.

4. Human papillomavirus (HPV) infection

Human papillomavirus has a high affinity with human squamous epithelium. Some people have found evidence of human papillomavirus infection in hyperplastic esophageal mucosa. However, the detection rate of human papillomavirus in esophageal papilloma is very inconsistent, and some authors report that human papillomavirus is negative. Therefore, the exact relationship between human papillomavirus and esophageal papilloma needs further study. This is the focus of controversy at present.

Endoscopy and biopsy

It is the first choice to find and diagnose EP. Endoscopy can directly observe the shape of lesions, mostly single lesions with flat mastoid, which can swing and drift with the passage of liquid in esophagus; Most of them are soft and easy to deform to the touch, and the size is mostly below 10mm (the largest report in China is 1 case 7cm, and the largest report abroad is 1 case 8 cm); Endoscopic biopsy can diagnose EP. Endoscopic staining of esophageal mucosa is helpful to improve the detection rate of EP. Lugo's iodine staining shows that normal squamous cells are brown after iodine exposure due to glycogen. The content of keratinized glycogen in EP squamous epithelium is less than normal, and the staining is shallow after iodine staining, which can also be distinguished from the uncontaminated area of early esophageal cancer.

(This picture is from Lilac Garden)

EP pathology

Pathological features: the lamina propria of esophageal mucosa sends out branched fiber vascular axes, covering the benign hyperplasia of stratified squamous epithelium, and the thickened squamous epithelium differentiates normally, showing a mature process from basal layer to surface layer. Echinodermosis hyperplasia, hyperkeratosis and dyskeratosis are common on the surface, but poorly keratinized cells, multinucleated giant cells and heterokaryocytes are rare. The connective tissue axis is not obvious, and it is composed of thin-walled blood vessels and interstitial cells, which are dendritic in distribution. Inflammation is often associated with nipple and neck, especially in esophagitis. The hollowing characteristics of some epithelial cells indicate that EP and EP are related.

Human papillomavirus infection is not unrelated.

Squamous epithelium is papillary hyperplasia.

(This pathological picture comes from Tiananmen teacher in Ya 'an Snow Mountain)

Koilocyte (this picture is from Gaochun Gao Fuping)

EP therapy

At present, there is no effective drug treatment for EP, and endoscopic resection is the first choice. There are many ways to resect lesions under endoscope, among which high frequency electrotomy is the most popular one at present. In recent years, there are argon, microwave and laser.

Law. For EP with a diameter less than 0.5cm, thermal biopsy forceps or electrocoagulation can be used for resection, or common biopsy forceps can be used for complete resection. If the diameter is greater than 0.5cm, endoscopic loop electrosurgical excision procedure (EMR), microwave, argon and other treatments can achieve good results.

(This picture comes from Tiananmen Teacher in Ya 'an Snow Mountain)

Document dispute point

Relationship between EP caused by human papillomavirus infection and esophageal cancer

Whether EP will become malignant has always been controversial. According to the statistics of domestic literature, the vast majority of EP are solitary small tumors, which are not easy to recur after treatment and resection, and the prognosis is good. But if the stimulus persists for a long time, it may recur. According to the data of molecular epidemiological investigation of esophageal cancer at home and abroad, it can be seen that human papillomavirus infection is positively correlated with the incidence of esophageal cancer in some high-incidence areas. It seems that human papillomavirus infection is closely related to esophageal cancer.

(This table is from Shantou teacher Zhang Donghong)

About human papillomavirus

Human Papillomavirus (Human)

Papillomavirus (human papillomavirus) is called "human" because its host is human. Human papillomavirus can cause human benign tumors and warts, such as human common warts, condyloma acuminatum and papilloma, which grow on the mucosa near reproductive organs. Since 1976 zur

Since Hansen put forward that human papillomavirus is a carcinogen of cervical cancer, the research on the relationship between human papillomavirus infection and cervical cancer has become a hot topic in the etiology of tumor virus. According to the different types of human papillomavirus and the risk of tumor occurrence, it can be divided into low-risk, high-risk and intermediate human papillomavirus. Intermediate human papillomavirus mainly includes 3 1, 33, 35 and 45, which can be detected in both benign and malignant tissues, so it is not the main type. Low-risk HPV types include HPV6, 1 1, 42, 43, 44, etc. , often cause benign lesions such as genital warts, including low-grade cervical intraepithelial lesions (CIN

I) High-risk human papillomavirus types include HPV 16, 18, 3 1, 33, 35, 39, 45, 5 1, 52, 56, 58, 59, 68, etc. Many scholars have noticed that human papillomavirus is related to many kinds of human cancers. In particular, HPV 16 and 1 1 were used to detect human papillomavirus infection in high incidence areas of esophageal cancer. Because of the different detection types, detection methods and the number of specimens in the tested areas, the results are quite different. Although human papillomavirus infection does exist, whether it is related to the occurrence of esophageal cancer needs further study.

At present, according to the reports of malignant transformation of EP in relevant literature, most people think that patients with huge EP or esophageal papillomatosis (EP is widely and densely distributed throughout the esophagus) have the possibility of malignant transformation; The long-term follow-up results of EP at home and abroad show that there is no report of single small lesion malignant transformation of EP at present.

It is worth mentioning that the author found that human papillomavirus (HPV) was mentioned in the chapter "Esophageal cancer" in the seventh edition of Undergraduate Clinical Medicine (Internal Medicine) (People's Medical Publishing House) (page 377). However, in the chapter of "Esophageal Cancer" in the eighth edition of "Undergraduate Clinical Medicine (Internal Medicine) Textbook" (People's Health Publishing House) (page 360), there is no mention of the cause of esophageal cancer (what do you mean by excluding this cause? ) human papillomavirus (human papillomavirus).

Whether esophageal papilloma induced by human papillomavirus is contagious and whether antiviral treatment is needed.

There is little literature on this issue. If esophageal papilloma is caused by human papillomavirus infection (and may be related to the pathogenesis of esophageal cancer), how does human papillomavirus infect esophageal mucosa? How to prevent it? Such documents are rare; Moreover, the author has not found any reports or studies on whether esophageal papilloma needs antiviral treatment, and most of them have not been treated with antiviral therapy after EP clamping or electrocoagulation, indicating that human papillomavirus infection may not be the main cause of EP infection, so the relationship between human papillomavirus infection and esophageal cancer needs further study.

In short, the discoloration of tumor (EP, human papillomavirus) is needless to say, and it is better to do endoscopic screening regularly. Once found, timely endoscopic treatment (forceps, hot biopsy forceps or electrocoagulation ablation, electric snare resection (EMR), argon knife (APC), etc.). ) can be eradicated, and the second is to obtain complete pathological specimens.