# Esophageal Squamous Papilloma and Papillomatosis: Current Evidence of HPV Involvement and Malignant Potential

## TL;DR

This review explores the potential link between esophageal squamous lesions and high-risk HPV, highlighting the need for better understanding of their cancer risk.

## Contribution

The paper provides a comprehensive review of the emerging evidence linking HPV to esophageal squamous lesions and their malignant potential.

## Key findings

- High-risk HPV genotypes may be associated with esophageal squamous papilloma and papillomatosis.
- Advanced endoscopic imaging improves detection of dysplastic changes in these lesions.
- Multifocal or HPV-positive cases require closer follow-up compared to solitary non-dysplastic lesions.

## Abstract

Esophageal squamous papilloma (ESP) and papillomatosis are rare esophageal lesions traditionally considered benign, yet emerging evidence suggests a possible association with high-risk human papillomavirus (HPV) infection and a potential risk of malignant progression. In this review, we summarize current evidence on their pathogenesis, clinical features, diagnostic approaches, and management strategies, with particular focus on the role of HPV. We also discuss the contribution of advanced endoscopic imaging in detecting lesions with dysplastic changes. Given the limited and heterogeneous data available, further research is urgently needed to clarify the oncogenic potential of these lesions and to optimize surveillance and treatment protocols.

Human papillomavirus (HPV) is a recognized oncogenic agent in several epithelial malignancies, though its role in esophageal squamous lesions remains unclear. Esophageal squamous papilloma and papillomatosis are rare, often benign lesions, but increasing evidence suggests possible associations with high-risk HPV genotypes and a non-negligible risk of dysplasia and malignant transformation. This narrative review summarizes current evidence on epidemiology, clinical features, histopathology, and diagnostic approaches, emphasizing advanced endoscopic imaging techniques that improve lesion detection and characterization. Management relies primarily on complete endoscopic resection with histological and virological evaluation. While small, non-dysplastic solitary lesions may not require routine surveillance, multifocal or high-risk HPV-positive cases warrant closer follow-up. Standardized HPV testing and long-term prospective studies are needed to better define the oncogenic potential and inform surveillance and treatment strategies.