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BRIEF REPORTS

A case of oropharyngeal squamous papilloma in which endoscopicresection was performed

Masakazu Takahashi, MD, Yuichi Shimizu, MD, Takeshi Yoshida, MD, Yasuaki Mori, MD,Manabu Nakagawa, MD, Junji Yamamoto, MD, Shoko Ono, MD, Soichi Nakagawa, MD, Katsuhiro Mabe, MD,Takahiko Kudo, MD, Mototsugu Kato, MD, Masahiro Asaka, MD

Sapporo, Japan

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CASE REPORT

A 56-year-old woman was referred to Hokkaido Uni-versity Hospital for endoscopic resection of a tumor in theoropharynx. Further endoscopic examination revealed alesion with a characteristic verrucous appearance reminis-cent of papillomatous warts seen on the skin and esoph-agus (Fig. 1A). Magnified narrow-band imaging showedthat microvessels in the lesion were not dilated (Fig. 1B).The lesion was diagnosed as an oropharyngeal squamouspapilloma. Endoscopic resection was selected as treat-ment. Written informed consent was obtained after weexplained the advantages and risks and before we initiatedtreatment.

The endoscopic resection procedure was performedwith the patient under conscious sedation by using a totalof 10 mg diazepam. An endoscope (EG 450 RDS; Toshiba-Fujinon, Tokyo, Japan) and an electrosurgical current gen-erator (ICC200; Erbe, Germany) were used for the proce-dure. Before resection, a total of 1.5 mL of 1% lidocainewas injected under the lesion to prevent pain during theresection and to obtain mucosal elevation. Endoscopicresection was performed by use of snare polypectomy,with the generator set at 120 W for endocut effect 3 mode,and a 40-W current for forced coagulation mode was usedfor additional coagulation to prevent hemorrhage (Fig. 2).The procedure was completed in 12 minutes. The patientdid not report pain or a burning sensation during theresection. Postoperative pain was controlled without usingan analgesic. The patient was allowed to eat soft food onthe day after resection and was discharged 2 days afterresection. The lesion in the resected specimen was 0.7 �0.4 cm in size. Histologic diagnosis revealed a squamouspapilloma with negative margins (Fig. 3).

DISCUSSION

Squamous papilloma is occasionally found in the esoph-agus by endoscopic examination; however, squamousapilloma of the pharynx is very rare. Esophageal papil-

omas are characterized histologically by finger-like pro-

ections of tissue lined by an increased number of squa- r

1270 GASTROINTESTINAL ENDOSCOPY Volume 76, No. 6 : 2012

ous cells and a core of connective tissue that containsmall blood vessels.1 Histologic findings of this case arehe same as histologic findings of esophageal squamousapilloma.Endoscopic resections of hypopharyngeal and oropha-

igure 1. A, Endoscopic view of the oropharynx of a 56-year-oldoman. A white-pinkish lesion with a characteristic verrucous appear-nce reminiscent of papillomatous warts can be seen. B, Endoscopicmage obtained by magnified narrow-band imaging shows microvesselsithout dilatation in each wart.

yngeal tumors usually are performed with patients under

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Brief Reports

general anesthesia because the hypopharynx and oro-pharynx are sensitive to pain stimulus, and an endoscopicprocedure at these sites would cause a gag reflex.2,3 How-ever, we previously reported successful endoscopic sub-

Figure 2. Endoscopic view after we performed endoscopic resection ofthe oropharyngeal lesion. No residual tumor can be seen.

Figure 3. Photomicrograph of the resected specimen showing a squa-mous papilloma. Adequate subepithelial tissue and a complete verticalmargin were obtained (H&E, orig. mag. �100).

mucosal dissection of oropharyngeal carcinoma by using a d

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ocal lidocaine injection, with the patient under consciousedation.4 We believe general anesthesia may be unnec-ssary for endoscopic resection of an oropharyngeal le-ion and decided to perform endoscopic resection for thisatient by using conscious sedation.It is controversial whether squamous papillomas should

e treated, because they are benign epithelial lesions;owever, some squamous papillomas have been reportedo become malignant.5,6 Endoscopic resection of the oro-haryngeal papilloma was not difficult or time-consuming.e therefore recommend endoscopic resection for pa-

ients with pharyngeal squamous papillomas.

ISCLOSURE

All authors disclosed no financial relationships relevanto this publication.

EFERENCES

. Carneiro TE, Marinho SA, Verli FD, et al. Oral squamous papilloma: clinical,histologic and immunohistochemical analysis. J Oral Sci 2009; 51:367-72.

. Shimizu Y, Yamamoto J, Asaka M, et al. Endoscopic submucosal dissec-tion for treatment of early stage hypopharyngeal carcinoma. Gastroin-test Endosc 2006; 64:255-9.

. Iizuka T, Kikuchi D, Hoteya S, et al. Endoscopic submucosal dissection fortreatment of mesopharyngeal and hypopharyngeal carcinomas. Endos-copy 2009; 41:113-7.

. Shimizu Y, Yoshida T, Takahashi M, et al. Endoscopic submucosal dissec-tion of oropharyngeal carcinoma by using local lidocaine injection withthe patient under conscious sedation. Gastrointest Endosc. Epub 2011Aug 9.

. Sandison A. Common head and neck cases in our consultation referrals:diagnostic dilemmas in inverted papilloma. Head Neck Pathol 2009;3:260-2.

. Mirza S, Bradley PJ, Acharya A, et al. Sinonasal inverted papillomas: recur-rence, and synchronous and metachronous malignancy. J Laryngol Otol2007;121:857-64.

hird Department of Internal Medicine, Hokkaido University Hospital, Sap-oro, Japan.

eprint requests: Masakazu Takahashi, MD, Third Department of Internaledicine, Hokkaido University Hospital, Kita 15 jo Nishi 7 chome, Kitaku,

apporo 060-8638, Japan.

opyright © 2012 by the American Society for Gastrointestinal Endoscopy016-5107/$36.00

oi:10.1016/j.gie.2012.01.006

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