Esophageal leukoplakia or epidermoid metaplasia: a clinicopathological study of 18 patients
Esophageal leukoplakia or epidermoid metaplasia: a clinicopathological study of 18 patients
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DOI：
10.1038/modpathol.2013.100
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发表时间：
2014-01-01
期刊：
影响因子：
7.5
通讯作者：
Montgomery, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Singhi, Aatur D.;Arnold, Christina A.;Montgomery, Elizabeth A.
口腔白斑是一种相对常见的无痛性口腔粘膜疾病。它主要影响中年至老年男性，并与吸烟和饮酒有很强的关联。伴随的组织学表现为角化过度和发育良好的颗粒细胞层，称为角化异常增生，常与口腔鳞状细胞癌有关。相比之下，食道内的类似病变（称为食道表皮样化生）很少遇到，并且文献中描述不多。为了更好地描述该实体的临床病理特征，我们收集了18例患者的25例病例。患者年龄范围为37 - 81岁（平均61.5岁），女性略多（10/18，56%）。就诊时，大多数患者主诉吞咽困难（10/18，56%）。11例（61%）患者的既往病史中有吸烟或长期二手烟史，7例（39%）患者有饮酒史。17例（94%）食管上皮样化生患者位于食管中远端。在组织学上，所有病例均明显分界，其特征为上皮增生、基底层增厚、棘层中区、突出的颗粒细胞层和浅表角化过度。18例患者中有3例（17%）观察到邻近高度鳞状不典型增生和/或鳞状细胞癌。13/18例（72%）患者的随访信息可用，范围为2 - 8.3年（平均2.3年）。13例患者中有7例（54%）有持续性疾病;然而，他们中没有一个发展为鳞状不典型增生或鳞状细胞癌。为了评估食管上皮样化生的发生率，在三个学术机构对198例连续食管活检进行了为期6个月的前瞻性调查。在这一时间范围内没有发现任何病例。总之，食管上皮样化生是一种罕见的条件，影响中至远端食管在中年至老年女性。邻近高度鳞状不典型增生和/或鳞状细胞癌的发生需要密切随访。
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.