Nipple-Like Focal Distal Esophageal Epidermoid Metaplasia

摘要

65-year-old male patient was admitted to hospital with alcoholic steatohepatitis. He underwent esophagogastroduodenoscopy to assess for upper gastrointestinal (GI) bleeding due to hemoglobin levels of 7.4 g/dL. While neither an active/potential bleeding source nor esophagogastric varices were to be identified, a tiny, nipple-like, whitish lesion, with an estimated diameter of 1.5 mm, was detected in the distal esophagus 1 cm above the Z-line (Fig. 1a). To improve visualization and operability during intended forceps removal, we switched to cap-fitted endoscopy with a long, small-diameter cap (Fig. 1b). The lesion was grasped under visual control (Fig. 1c), resulting in a macroscopic complete one-piece resection (Fig. 1d). Pathologic evaluation of the targeted biopsy indicated squamous epithelium with hyperorthokeratosis, and a prominent granular layer, resembling the epidermis of the skin (Fig. 1e, f). Overall, the lesion was characterized as epidermoid metaplasia without signs of dysplasia.