A 73-year-old male patient with a remote history of oropharyngeal cancer treated by surgery and postoperative radiochemotherapy presented with acute abdominal pain, and, therefore, underwent esophago-gastro-duodenoscopy. Beyond minor shallow ulcerative peptic duodenitis as the most likely cause for the clinical symptoms, in the esophagus multiple patches of whitish colored areas with plaque-like elevations came to our notion reminiscent of oral leukoplakia. Further endoscopic assessment indicated sharply demarcated reptile skin-like lesions with mucosal thickening predominant in the distal esophagus. (Fig. 1A) Chromoendoscopy using 1% Lugol solution staining glyco-gen in squamous epithelium confirmed complete sparing of these lesions with the background mucosa being unremarkable, thus precluding targeted biopsies. (Fig. 1B) Pathologic evaluation of multiple biopsies indicated stratified squamous epithelium with acanthosis and hypergranulosis with compact hyperorthokeratosis, whereas the basal cell layers appeared normal. (Fig. 1C + D; H&E x 2.5 and x 10, respectively). Taken together, these findings confirmed the presence of epidermoid metaplasia without signs of dysplasia.
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