HPV may be often detected in the squamous epithelium of the esophagus and is considered to be related to the appearance of benign lesions with no risk of progression. Several studies have tried to identify a potential role of HPV in esophageal SCC carcinogenesis but results have been non-conclusive yet (4). The first peculiar finding of our case report is that the presence of HPV was suspected on the basis of the histologic similarities between tissue from the neoplastic esophageal lesion and tissues from typical HPV related cervical neoplasms. Interestingly, HPV infection was then confirmed by microbiologic assays exclusively in the areas with neoplastic changes
but not in the surrounding
Inhibitors,research,lifescience,medical healthy esophageal epithelium. Inhibitors,research,lifescience,medical Moreover the most virulent HPV genotype was identified, which may have been associated with neoplastic progression of this HPV-related esophageal lesion. The second point of interest in this case is the efficacy of a single course of RFA on neoplastic change and HPV infection as well. Biopsy specimens from three subsequent Inhibitors,research,lifescience,medical endoscopic exams have demonstrated a complete histological response with absence of residual dysplasia and eradication of HPV colonization. Some small prospective studies have already suggested the potential role of RFA in patients with early squamous cell neoplasia of the esophagus but this therapeutic approach has never been evaluated in the setting of controlled trials (12-14). Our experience supports this possible new use of the HALO90 RFA procedure in patients with superficial early squamous cell neoplasia, suggesting the treatment can be effective with potential lower complications rates than more invasive techniques Inhibitors,research,lifescience,medical such as EMR, ESD and esophagectomy. Moreover, since the etiologic role of HPV in esophageal carcinogenesis is uncertain, our case may facilitate discussion regarding the appropriateness of regular endoscopic follow-up in patients with HPV esophageal colonization and of eventual prophylactic treatment of benign HPV-related lesions. Dipeptidyl peptidase Further investigations are Inhibitors,research,lifescience,medical warranted. Acknowledgements
Disclosure: The authors declare no conflict of interest.
The incidence and mortality from cancer of all types in the United States has decreased during the 1991-2006 timeframe (1). However, the opposite is true for esophageal cancer. Its incidence and mortality continue to rise. In 2010, estimated new cases of esophageal cancer number 16,640 in the United States, while deaths total 14,500 (1). The United States has seen an average increase of 20.6% per year in the incidence of adenocarcinoma of the esophagus since that time (2). Esophageal cancer is a highly lethal disease in which only one-third of patients present with resectable disease. Of this select group, the average 5-year survival is only 35-45% (3).