Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
Histopathology. 2013 Oct;63(4):463-73. doi: 10.1111/his.12195. Epub 2013 Jul 23.
Oesophageal hyperkeratosis is rarely described. In contrast to hyperkeratosis of orolaryngeal mucosa, where its risk factors and association with squamous neoplasia are well-studied, the prevalence and clinicopathological features of oesophageal hyperkeratosis are unknown.
We reviewed prospectively 1845 oesophageal biopsies and found hyperkeratosis in 37 (2.0%). Among 98 patients studied, hyperkeratosis occurred in two distinct settings: group 1 [within Barrett's oesophagus (BO)/adenocarcinoma, n = 61, 62%] and group 2 (outside BO/adenocarcinoma, n = 37, 38%). In contrast to group 1, hyperkeratosis in group 2 was more often multifocal (>3 foci in 51% versus 16%, P = 0.0001), involved mid-oesophagus (51% versus 2%, P < 0.0001), showed endoscopic leucoplakia (24% versus 3%, P = 0.003) and involved current/former alcohol users (51% versus 19%, P = 0.0012). Importantly, invasive squamous carcinoma and squamous dysplasia were seen only in group 2 (47% and 19% versus 0%, P < 0.0001). Further, 42% of group 2, but none of group 1, had benign or malignant squamous lesions of the oral cavity/larynx (P < 0.0001).
Hyperkeratosis involves ~2% of oesophageal biopsies and can be divided into cases occurring within BO/adenocarcinoma and those occurring outside BO/adenocarcinoma. The former lack clinical significance, whereas the latter are associated frequently with oesophageal squamous neoplasia and squamous pathology of the head and neck region.
食管角化过度症很少见。与口咽黏膜角化过度不同，后者的危险因素及其与鳞状肿瘤的关系已得到充分研究，食管角化过度症的患病率和临床病理特征尚不清楚。
我们前瞻性地复习了 1845 例食管活检标本，发现 37 例（2.0%）存在角化过度。在 98 例研究患者中，角化过度发生在两种不同的情况下：第 1 组[在 Barrett 食管（BO）/腺癌中，n=61，62%]和第 2 组（BO/腺癌之外，n=37，38%）。与第 1 组相比，第 2 组的角化过度更常为多灶性（51%比 16%，P=0.0001），累及食管中段（51%比 2%，P<0.0001），表现为内镜下的白色斑块（24%比 3%，P=0.003），并累及当前/曾经的酒精使用者（51%比 19%，P=0.0012）。重要的是，仅在第 2 组中发现浸润性鳞状癌和鳞状不典型增生（47%和 19%，而第 1 组为 0%，P<0.0001）。此外，第 2 组中有 42%（但第 1 组无）存在口腔/喉部的良性或恶性鳞状病变（P<0.0001）。
角化过度占食管活检的~2%，可分为发生在 BO/腺癌内和发生在 BO/腺癌外的病例。前者缺乏临床意义，而后者常与食管鳞状肿瘤和头颈部区域的鳞状病变相关。
