Department of Pathology, UPMC Presbyterian Hospital, Pittsburgh, PA, USA.
Department of Pathology, Ohio State University, Columbus, OH, USA.
Mod Pathol. 2014 Jan;27(1):38-43. doi: 10.1038/modpathol.2013.100. Epub 2013 Jun 14.
Oral leukoplakia is a relatively common, painless disorder of the oral mucosa. It predominantly affects middle-aged to elderly men and has a strong association with tobacco smoking and alcohol intake. Concomitant histological findings of hyperorthokeratosis and a well-developed granular cell layer, termed orthokeratotic dysplasia, are often associated with oral squamous cell carcinoma. In contrast, analogous lesions within the esophagus, termed esophageal epidermoid metaplasia, are rarely encountered and poorly described in the literature. To better characterize the clinicopathological features of this entity, we have collected 25 cases from 18 patients. Patients ranged in age from 37 to 81 years (mean, 61.5 years), with a slight female predominance (10/18, 56%). On presentation, a majority of patients complained of dysphagia (10/18, 56%). Past medical history was significant for tobacco smoking or long history of second-hand smoke in 11 (61%) patients and alcohol intake in 7 (39%) patients. Seventeen (94%) patients with esophageal epidermoid metaplasia were located within the middle-to-distal esophagus. Histologically, all cases were sharply demarcated and characterized by epithelial hyperplasia, a thickened basal layer, acanthotic midzone, a prominent granular cell layer, and superficial hyperorthokeratosis. Adjacent high-grade squamous dysplasia and/or squamous cell carcinoma were seen in 3 out of 18 (17%) patients. Follow-up information was available for 13 out of 18 (72%) patients and ranged from 2 to 8.3 years (mean, 2.3 years). Seven of the 13 (54%) patients had persistent disease; however, none of them developed squamous dysplasia or squamous cell carcinoma. In an effort to assess the incidence of esophageal epidermoid metaplasia, 198 consecutive esophageal biopsies were prospectively surveyed over a 6-month period at three academic institutions. No cases were identified within this time frame. In summary, esophageal epidermoid metaplasia is a rare condition affecting the middle-to-distal esophagus in middle-aged to elderly females. The occurrence of adjacent high-grade squamous dysplasia and/or squamous cell carcinoma warrants close follow-up.
口腔白斑病是一种较为常见的、无痛性口腔黏膜疾病。它主要影响中年到老年男性，与吸烟和饮酒有很强的关联性。同时存在的组织学表现为过度正角化和发达的颗粒细胞层，称为正角化发育不良，常与口腔鳞状细胞癌相关。相比之下，类似的食管病变，称为食管表皮化生，在文献中很少见且描述不佳。为了更好地描述该实体的临床病理特征，我们从 18 名患者中收集了 25 例。患者年龄从 37 岁到 81 岁（平均 61.5 岁），女性略占优势（10/18，56%）。就诊时，大多数患者主诉吞咽困难（10/18，56%）。11 名（61%）患者有吸烟史或长期二手烟暴露史，7 名（39%）患者有饮酒史。17 名（94%）食管表皮化生患者位于食管中段至远段。组织学上，所有病例边界清晰，表现为上皮增生、基底层增厚、棘皮中层、明显的颗粒细胞层和浅层过度正角化。18 例中有 3 例（17%）患者伴有高级别鳞状上皮内瘤变和/或鳞状细胞癌。18 例中有 13 例（72%）患者获得随访信息，随访时间为 2 至 8.3 年（平均 2.3 年）。13 例中有 7 例（54%）患者疾病持续存在；然而，他们均未发展为鳞状上皮内瘤变或鳞状细胞癌。为了评估食管表皮化生的发生率，我们在 3 家学术机构前瞻性地对 198 例连续食管活检进行了为期 6 个月的调查，在此期间未发现病例。总之，食管表皮化生是一种罕见的疾病，影响中年到老年女性的食管中段至远段。伴有高级别鳞状上皮内瘤变和/或鳞状细胞癌的发生需要密切随访。
