Endoscopic mucosal resection of rectal squamous cell papilloma

A 22-year-old male patient presented with a 3-month history of persistent, colicky, lower abdominal pain. He was referred for colonoscopy. Total colonoscopy showed multiple small-to-medium sized pale pink, nonulcerated, polypoid lesions in the distal part of the rectum, occupying most of the circumference ([Fig. 1]).

Fig. 1 Endoscopic view of squamous cell papilloma of the rectum using white light (a,c,d) and narrow-band imaging (b,e).

The patient’s medical history was not significant. After discussing his sexual history, he mentioned having a male partner for 2 years. Basic investigations were carried out, including human immunodeficiency virus serology; they were all negative. After discussing the treatment options with the patient, endoscopic mucosal resection of the lesions was performed ([Fig. 2], [Video 1]). Histopathological examination showed squamous cell papillomatosis of the rectum, with mild-to-moderate atypia ([Fig. 3]). Isolation of the human papilloma virus (HPV) from the specimen was not possible.

Fig. 2 Complete endoscopic mucosal resection of squamous cell papilloma.

Video 1 Endoscopic mucosal resection of rectal squamous cell papilloma.

Fig. 3 Histopathological examination. a, b Hyperplastic stratified squamous epithelium with keratosis, vascular cores (a, arrow), and epitheliosis (b, arrow). c Squamous cell papilloma (SCP) with mild atypia (arrow). d SCP with focal moderate atypia (arrow).

Squamous cell papilloma (SCP) is a benign lesion that is a result of infection with HPV [1]. HPV-associated diseases are sexually transmitted and mainly affect the genitals, causing wart formation [2]. SCP arises from the stratified squamous epithelium of the skin, lip, oral cavity, tongue, pharynx, larynx, esophagus, cervix, vagina or anal canal [3]. SCP of the gastrointestinal tract is mainly localized to the oropharynx, esophagus, and anal canal [4]. The current case was an extremely rare case of rectal SCP.

Endoscopy_UCTN_Code_CCL_1AD_2AC

• References

• 1 New Zealand Dermatological Society. Squamous cell papilloma. New Zealand Dermatological Society. Available from: https://www.dermnetnz.org/topics/squamous-cell-papilloma/ Accessed November 2007
• 2 Ljubojevic S, Skerlev M. HPV-associated diseases. Clin Dermatol 2014; 32: 227-234
• 3 Gerada J, Savic A, Vassallo M. Squamous papilloma of the anal canal. Endoscopy 2013; 45: E42-E43
• 4 Karantanis D, Allen-Auerbach M, Czernin J. Squamous papilloma of the oral cavity and oropharynx on 18F-FDG PET/CT imaging. Clin Nucl Med 2012; 37: e98-e99