A Rare Case of Hyperplastic Proximal Esophageal Polyps With Foveolar Dysplasia

Abstract

A 62-year-old male with long-standing esophageal reflux underwent endoscopy at an outside institution that reported multiple polypoid lesions in upper esophagus and a small focal area of nodular mucosa at the gastroesophageal junction(GEJ). Biopsies of the proximal esophageal polyps demonstrated hyperplastic mucosa with ulceration, reactive epithelial changes, and focal intestinal metaplasia. Biopsies from the nodular GEJ mucosa were described as Barrett’s esophagus with low grade dysplasia. An upper endoscopy performed at our medical center found multiple semi-pedunculated esophageal polyps between 18-24 cm from the incisors (Figure A).Endosonographically the polypoid lesions were confined to the mucosa with normal underlying wall layers (Figure B). Patient underwent endoscopic mucosal resection (EMR) using a multi-band mucosectomy technique. Hematoxylin and eosin staining of the EMR specimens showed gastric and intestinal metaplasia, featuring cubital to columnar cells with pale clear to light eosinophilic cytoplasm and round to oval nuclei (Figure C). MUC5AC (a marker of gastric foveolar mucin) was positive in the specimen (Figure D); whereas intestinal markers MUC2, CDX-2 and Villin, were negative. The impression of the gastrointestinal pathologists was hyperplastic polyp with foveolar dysplasia. At a follow-up endoscopy 3 months later, smooth mucosal scarring was noted with no residual polypoid tissue or gastric heterotopia.