Squamous cell carcinoma arising in esophageal lichen planus

Carlo Calabrese, MD, PhD, Anna Fabbri, MD, Marco Benni, MD, Alessandra Areni, MD, Carlo Scialpi, MD, Mario Miglioli, MD, Giulio Di Febo, MD Lichen planus (LP) is a chronic disease of skin and other squamous epithelium of unknown etiology. The estimated prevalence ranges from 0.02% to 2%. 1"3 An association has been suggested with acute alopecia and chronic hepatitis, especially hepatitus C virus-induced, and autoimmune disorders. 4-6 Although LP of the skin affects both genders with equal frequency and can appear at any age, mucosal LP is mainly a disease of middle-aged women.7, 8 It can involve the oral cavity, pharynx, esophagus, geni- talia, and anus. 3 Coexistent skin lesions are present in approximately 30% to 50% of patients.9,10 Skin lesions are tiny, flat-topped, violaceus papulae, ofter~ with a network of delicate white lines on the surface. Mucosal IJP has a different pattern: it is more com- monly found within the oral cavity and it appears in at least 6 forms that can occur separately or simulta- neously: reticular, papular, plaque-like, atrophic, ero- sive, and bullous. 11 Esophageal involvement in LP is rare, but its prevalence is probably underestimated. 12 Only 35 cases have been reported in French and English language publications to date. 1-3,7,8-10,12-33 At endoscopy, the most common features include peeling mucosae and plaque-like lesions and/or benign stric- tures in the proximal and middle thirds of the esoph- agus. It can involve the entire length of the esopha- gus, but the gastroesophageal junction is always spared. Histopathol0gic features are nonspecific and resemble those of chronic mucosal inflammation. In particular, the band-like infiltrate with a predomi- nance of mature T-cells and basal layer degeneration, including characteristic Civatte bodies, typical of skin involvement may not be present.7,19, 22 Mucosal LP has a recognized risk of malignant transformation to squamous cell carcinoma (SCC) of approximately 0.5% to 1%. 34-36 However, no case of malignant evolu- tion of esophageal LP has been described to date. CASE REPORT A 49-year-old white woman was referred to our endo- scopic unit because of recurrent epigastric pain, regurgita