Ashraf Muhammad Farhan, Richter Seth, Arker Soe H, Parsa Nour
Internal Medicine, Albany Medical Center, Albany, USA.
Gastroenterology and Hepatology, Albany Medical Center, Albany, USA.
Cureus. 2021 Aug 15;13(8):e17205. doi: 10.7759/cureus.17205. eCollection 2021 Aug.
Esophageal leukoplakia or epidermoid metaplasia is a rare lesion resembling the commonly found oral leukoplakia. When found, it is typically seen incidentally on endoscopy as a white plaque but rarely it may present as a globus sensation. Histologically, it is seen as epidermal metaplasia with orthokeratosis, closely resembling the skin. Although rare, esophageal leukoplakia is precancerous and may pose a serious threat. We present a unique case of a 61-year-old male with a history of COPD, tobacco, and alcohol dependence presenting with a six-month history of nausea and emesis resulting in poor oral intake despite having an appetite. The patient also reported weight loss. Considering his risk factors for esophageal carcinoma and alarm symptoms, an upper endoscopy was performed that revealed localized white, plaque-like mucosal changes characterized by altered texture in the lower third of the esophagus at 40cm. Biopsy results showed squamous epithelium with orthokeratosis and a prominent granular cell layer. These findings were consistent with esophageal epidermoid metaplasia. The lesion was ablated using argon plasma coagulation and radiofrequency ablation on subsequent endoscopy. The patient reported continued resolution of symptoms with each treatment session. Esophageal leukoplakia may increase the risk for squamous cell carcinoma of the esophagus and should be followed closely. Guidelines on surveillance are yet to be established given the rarity of the disease.
食管白斑或表皮化生是一种罕见的病变，类似于常见的口腔白斑。发现时，通常在内镜检查中偶然发现为白色斑块，但很少表现为咽部异物感。组织学上，它表现为伴有正角化的表皮化生，与皮肤非常相似。尽管罕见，但食管白斑是癌前病变，可能构成严重威胁。我们报告了一例独特病例，一名61岁男性，有慢性阻塞性肺疾病、吸烟和酒精依赖史，出现恶心和呕吐6个月，尽管有食欲但经口摄入量不佳。患者还报告体重减轻。考虑到他患食管癌的风险因素和警示症状，进行了上消化道内镜检查，发现食管下段40cm处有局限性白色斑块样黏膜改变，其特征为质地改变。活检结果显示鳞状上皮伴有正角化和明显的颗粒细胞层。这些发现与食管表皮化生一致。在随后的内镜检查中，使用氩离子凝固术和射频消融术对病变进行了切除。患者报告每次治疗后症状持续缓解。食管白斑可能会增加食管鳞状细胞癌的风险，应密切随访。鉴于该疾病罕见，尚未制定监测指南。
