High-Grade Squamous Intraepithelial Lesion of the Gastroesophageal Junction Secondary to High-Risk Human Papillomavirus.

OBJECTIVES: Although the role of human papillomavirus (HPV) in the development of some carcinomas (eg, anogenital and oropharyngeal squamous cell carcinomas) is nondebatable, there is still significant controversy regarding the relationship of HPV and esophageal squamous cell carcinomas (SCCs). METHODS: All cases were sampled at or near the gastroesophageal junctions in patients with reflux and/or known Barrett esophagus and appear to have been initially sampled "incidentally." Patients were all men, aged 56 to 80 years. None had a known history of other HPV-related disease. RESULTS: We present four cases of high-grade squamous intraepithelial lesion of the gastroesophageal junction secondary to high-risk HPV that have identical histologic features to similar lesions of the anogenital tract. CONCLUSIONS: Whether such lesions are at risk for developing into invasive SCC remains unclear.

Esophageal pneumatosis: Case report and review of literature.

Pneumatosis of the gastrointestinal tract is defined as presence of air in the wall of the gastrointestinal tract and can occur in any part of the gastrointestinal tract. It is most commonly seen in the intestine and very rarely in the esophagus. The exact pathogenesis is still unknown. It is managed primarily by conservative and non-surgical therapy, unless there are findings to suggest an acute abdomen or other co-morbidities. On review of literature, very few case reports of esophageal pneumatosis have been published. We present a rare case of pneumatosis of the esophagus with cytomegalovirus (CMV) infection.

A case report: Does the ulcer belong to esophageal carcinoma or HIV?

RATIONALE: The deep-rooted pathogenesis of the human papilloma virus (HPV) infection is still uncertain and argumentative. As we know, a lot of cases of esophageal infections, such as esophageal squamous cell carcinoma (ESCC) and esophageal squamous papilloma (ESP), associated with HPV are reported. However, primary esophageal ulcer infection associated with HPV is unusual. PATIENT CONCERNS: This case is different from the other reports associated with HPV due to the patient's favorable prognosis. DIAGNOSES: We present a case of a man diagnosed in the Gastroenterology Department of Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, which presented a deep and big esophageal ulcer with irregular borders caused by type 16 HPV infection. INTERVENTIONS: The esophageal ulcer was treated with vidarabine monophosphate treatment. OUTCOME: The esophageal ulcer was cured. LESSONS: We could put forward the diagnostic criteria available for diagnostic guidelines and 2 hypotheses that could possibly prevent esophageal carcinoma from happening.

Giant idiopathic ulcer of esophagus in the context of acquired immunodeficiency syndrome (AIDS).

The giant ulcer of esophagus is a rare entity in the context of human immunodeficiency syndrome. In front of this type of ulceration the radiologist must to distinguish between two types of ulcers HIV, cytomegalovirus (CMV). The differential diagnosis is necessary for orientation of the therapy and is the result of association between radiological, endoscopic and pathological findings.

Malakoplakia of the esophagus caused by human papillomavirus infection.

Malakoplakia is a rare granulomatous disease probably caused by infection and characterized histologically by Michaelis-Gutmann bodies. We report a more rarely seen case esophageal malakoplakia in a 54-year-old woman. She presented with coughing while eating and drinking. Gastroscopy showed yellow nodules in the esophagus, and endoscopic ultrasonography showed a space-occupying lesion in the substratum of the esophageal mucosa. All findings highly resembled esophageal cancer. Histopathological examination finally indentified this space-occupying lesion as malakoplakia and not cancer. Immunohistochemistry showed that she had human papillomavirus (HPV) infection in the esophagus, which indicates that infection was responsible for the malakoplakia. This is believed to be the first case of malakoplakia in the esophagus, and more importantly, we established that HPV infection was the initiator of esophageal malakoplakia.

Clinical relevance of novel Otarine herpesvirus-3 in California sea lions (Zalophus californianus): lymphoma, esophageal ulcers, and strandings.

Herpesviruses have been recognized in marine mammals, but their clinical relevance is not always easy to assess. A novel otarine herpesvirus-3 (OtHV3) was detected in a geriatric California sea lion (Zalophus californianus), and using a newly developed quantitative PCR assay paired with histology, OtHV3 was associated with esophageal ulcers and B cell lymphoblastic lymphoma in this animal. The prevalence and quantities of OtHV3 were then determined among buffy coats from 87 stranded and managed collection sea lions. Stranded sea lions had a higher prevalence of OtHV3 compared to managed collection sea lions (34.9% versus 12.5%; p = 0.04), and among the stranded sea lions, yearlings were most likely to be positive. Future epidemiological studies comparing the presence and viral loads of OtHV3 among a larger population of California sea lions with and without lymphoid neoplasia or esophageal ulcers would help elucidate the relevance of OtHV3-associated pathologies to these groups.

Cytomegalovirus infection of the upper gastrointestinal tract: a clinical and pathological study of 30 cases.

OBJECTIVE: The study reviews the endoscopic and histological features of human cytomegalovirus (HCMV) infections of the upper gastrointestinal (UGI) tract. MATERIALS AND METHODS: Clinical histories, endoscopic findings and bioptic specimens of 30 cases of HCMV infection of the UGI tract, diagnosed in a University Hospital in a 10-year period, were reviewed. In all cases, viral inclusion bodies were detected in routine histopathological sections and the diagnosis was confirmed with immunohistochemistry. RESULTS: Six patients were HIV+, whereas four had received organ transplantations, one was affected by common variable immunodeficiency and four had a recent history of malignancy. No other pathologic condition was evidenced in the remaining 15 cases. Mucosal alterations were endoscopically observed in the stomach (19 cases), esophagus (9), cardias (6) and duodenum (1), and multiple organs being synchronously affected in five patients (3 HIV+, 2 with history of malignancy). The antropyloric area was the most frequently affected site. Single ulcers were detected in 11 cases and multiple ulcers in 8, whereas mucosal thickenings (in the form of localized thickenings, polyps or rugal hypertrophy) were present in 13 patients. Thickenings of the mucosa were detected only in the stomach. At histology, necrotic material and granulation tissue were associated with moderate or marked lympho-plasmacytic infiltrate and foveolar hyperplasia in ulcerative lesions, whereas lesions labeled as mucosal thickenings showed mild or moderate chronic inflammatory infiltrate and foveolar hyperplasia. CONCLUSIONS: Endoscopic manifestations of UGI tract involvement in HCMV infection are not specific, varying from erythematous mucosa to ulcers to mucosal thickenings.