A Rare Case of Esophageal Leukoplakia: A Potential Precursor to Esophageal Malignancy

Abstract

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.

A Rare Case of Esophageal Leukoplakia in Achalasia

“…The exact etiology of esophageal leukoplakia is unknown [ 5 ]. Association with alcohol consumption, tobacco smoking, or response to chronic acid reflux have been reported [ 6 ].…”

“…Esophageal leukoplakia is typically an incidental finding. Patients are usually asymptomatic but can present with globus sensation or dysphagia [ 5 , 6 ]. Endoscopic features include elevated scaly or white plaque, clearly demarcated borders from the surrounding normal tissue, a cobblestone or shaggy surface, and translucent white color.…”

“…Characteristic histological findings of esophageal leukoplakia include acanthosis, hyperplasia, and superficial esophageal squamous mucosa parakeratosis. A key histopathologic feature of esophageal leukoplakia is a marked granular layer with an overlying hyperorthokeratotic layer, similar to the epidermis of the skin [ 3 , 5 ].…”

Endoscopic submucosal dissection for treatment of esophageal leukoplakia reveals hidden histopathology

“…Due to the rarity of the disease, guidelines for surveillance and treatment have not yet been established. The approaches predominantly described in the literature include either frequent endoscopic surveillance or treatment via radiofrequency ablation or argon plasma coagulation 3 . Regarding the growth pattern, extent of the lesions, and potential for malignant transformation, endoscopic submucosal dissection (ESD) was suggested to ensure a complete resection.…”

Esophageal epidermoid metaplasia: A rare condition in the pediatric population

“…It is an incidental finding on endoscopy and is described as epidermal metaplasia with orthokeratosis, closely resembling skin. 1 Currently, the disease process is only described in adult studies. Clinical information, extrapolated from case series, has demonstrated the most common presenting complaint is dysphagia.…”