Esophageal Leukoplakia: Risk Factors and Relationship to Squamous Neoplasia
MW Taggart, A Rashid, SC Abraham. MD Anderson Cancer Center, Houston, TX
Background: Leukoplakia of the oropharynx is a relatively common lesion that is associated with radiation and tobacco use and is a known risk factor for progression to squamous carcinoma (SCC). In contrast, esophageal keratosis is unusual and its clinical associations are not well-characterized.
Design: We studied 42 patients with esophageal hyperkeratosis (with or without leukoplakia by endoscopy) diagnosed over a 15 year period. Clinical parameters including history of head & neck pathology, smoking, alcohol use and reflux disease were obtained from the medical files. Histologic slides were reviewed jointly by 2 pathologists for the following features: hyperkeratosis extent, presence of parakeratosis, infection, squamous dysplasia and SCC.
Results: Esophageal hyperkeratosis was seen in 87 biopsy sites from 42 patients (mean age 65 yr, range 36-82 yr). Twelve (29%) had a history of radiation to the chest or head & neck. Parakeratosis was also present in 35 (83%) patients and infection in 19 (45%), including bacterial colonization (n=11), Candida (n=3) or both (n=5). Hyperkeratosis involved nondysplastic mucosa in 28 (67%) patients, squamous dysplasia in 8 (19%) and both dysplastic and nondysplastic mucosa in 6 (14%). These 42 patients appeared to fall into 2 main groups: hyperkeratosis found during surveillance for Barrett esophagus or adenocarcinoma (group 1, n=15) and all others (group 2, n=27). There were no differences in age, presence of parakeratosis, or smoking, but there were trends toward higher F:M ratio, greater extent of hyperkeratosis, and higher prevalence of infection in group 2. Group 2 had significantly greater alcohol history, head & neck pathology (SCC in 7, squamous dysplasia in 4, leukoplakia in 4, and lichen planus in 3), and esophageal squamous dysplasia and /or SCC (see Table 1).
Conclusions: Risk factors for esophageal hyperkeratosis appear similar to those of oropharyngeal leukoplakia, particularly in the non-Barrett setting. These patients frquently (44%) have accompanying benign or malignant oral/laryngeal pathology. Because of the frequent association between esophageal hyperkeratosis and esophageal dysplasia/SCC, it may represent a preneoplastic condition.
|Hyperkeratosis setting||Sex (male)||*Tobacco (>10 pack yr)||*Alcohol (>2/day)||Head&neck pathology||Extent of hyperkeratosis (>3 foci)||SCC||Squamous dysplasia only|
|All others (n=27)||59%||67%||41%||44%||52%||35%||23%|