Esophageal Epidermoid Metaplasia: Clinical Characteristics and Risk of Esophageal Squamous Neoplasia

Abstract

INTRODUCTION: Esophageal epidermoid metaplasia (EEM) is a rare disease. METHODS: Patients with EEM diagnosed between 2014 and 2020 were reviewed. RESULTS: Forty EEM cases were identified. EEM occurred in 9 (23%) patients before, concordant, or after esophageal squamous cell carcinoma (ESCC). EEM was associated with previous esophageal lichen planus in 5 patients, Barrett's esophagus 7, and esophageal adenocarcinoma 1. EEM was focal in 28 (70%) or diffuse in 12 (30%) and not detected in 45% on recent previous endoscopy. DISCUSSION: EEM is a premalignant underrecognized condition associated with multiple conditions. Close follow-up or endoscopic treatment may be warranted because of its ESCC association.

A Rare Case of Esophageal Leukoplakia in Achalasia

“…Esophageal leukoplakia is often detected in close proximity to high-grade squamous cell dysplasia and squamous cell carcinoma suggesting it to be a preneoplastic lesion [ 1 ]. In a case series by Kamboj et al with 40 patients with EEM 25% of the patients were found to have squamous cell neoplasia before, synchronous to, or after epidermoid metaplasia of the esophagus [ 8 ]. Singhi et al reported a case series with 18 patients with esophageal leukoplakia amongst which 17% had high-grade dysplasia or even squamous cell carcinoma [ 1 ].…”

“…No guidelines exist for the ideal frequency and pattern for evaluation or surveillance of esophageal leukoplakia [ 10 ]. Given concern for preneoplastic potential and its association with squamous cell dysplasia and esophageal cancer, the need for close surveillance or endoscopic interventions has been suggested [ 1 , 8 ]. Endoscopic resections for small dysplastic lesions and ablation therapy for large dysplastic lesions have been proposed.…”

“…Endoscopic resections for small dysplastic lesions and ablation therapy for large dysplastic lesions have been proposed. Further on, follow up with endoscopic targeted quadrantic biopsies every 1-2 cm done every six months followed by annual surveillance if no dysplasia or progression is seen for diffuse panesophageal or non resectable lesions without dysplasia were suggested [ 8 ].…”

Shaggy white lesion with morphological changes in the oesophagus

“…Heavy smoking and alcohol intake are proposed risk factors, although the aetiology remains uncertain 2 3. Epidermoid metaplasia is associated with synchronous or metachronous squamous neoplasia and premalignant conditions, such as lichen planus and Barrett’s oesophagus 4. The presence of multiple mutations, including TP53, in epidermoid metaplasia corroborates its malignant potential 5.…”

Histomorphology and Molecular Profiling of Well-Differentiated Squamous Cell Carcinoma of the Esophagus Including its Unusual Variants

“…2d). 20,21 Kamboj et al identified that 25% (10 of 40) of patients with an EEM diagnosis had squamous neoplasia diagnosed (before, at, or after EEM diagnosis). 20 Cottreau et al also reported an increased prevalence of EEM in patients with squamous neoplasms.…”