Alan Makedon, BA1, Youssef Botros, MD2, Ariy Volfson, MD2
1SUNY Upstate Medical University, Syracuse, NY; 2St. Joseph's University Medical Center, Paterson, NJ
Introduction: Esophageal melanosis a rare disease of the digestive system which is characterized by melanocytic proliferation in the squamous epithelium of the esophagus and melanin accumulation of esophageal mucosa (EM). It was first described by De la Pava in 1963. The disease is extremely rare in Western countries and most of the previously reported cases were diagnosed in Japan and India. Despite an unclear pathogenesis, esophageal melanosis hypothesized to arise from chronic irritation of the esophageal mucosa that stimulate keratinocyte differentiation and subsequent hyperplasia in the basal epithelial layer of EM. Differential diagnoses of esophageal melanocytosis from its histologic mimics include benign melanocytic nevi and malignant melanoma. Esophageal melanosis has been reported to be the precursor lesion for esophageal melanoma. We report a case of esophageal melanosis in a 61-year-old woman who had esophagogastroduodenoscopy (EGD) done for dyspepsia.
Case Description/Methods: A 61-year- old female with past medical history of hypertension presented to the gastroenterology service for persistent dyspepsia. She had a 10 pack-year smoking history. She had no history of acid reflux. Physical examination and blood work were unremarkable. EGD was performed and showed a pigmented (black) flat mucosal lesion in the middle third of the esophagus. Multiple biopsies were obtained. Histopathology showed squamous mucosa, with an organized cellular architecture, surface maturation, and lack of cellular atypia but with an increased lymphocytic infiltrate of the epithelium, with an increase in melanocytosis consistent with the features of esophageal melanosis. The patient was started on a proton-pump inhibitor with recommendations to repeat EGD in 1 year.
Discussion: Currently, one theory of esophageal melanosis pathogenesis implicates aberrant melanocyte migration during fetal development. Another theory suggests that esophageal melanosis arises from keratinocytic differentiation and subsequent hyperplasia in the basal epithelial layer of EM as a result of chronic acid reflux, Addison’s Disease, or chronic inappropriate eating. It is possible that combination of both conditions is likely to be stronger. Chronic alcohol use, cigarette smoking, diet and hereditary factors might also be associated with development of esophageal melanosis. Recognition of this lesion on endoscopy is important given the potential differential diagnosis including esophageal melanoma.
Citation: Alan Makedon, BA; Youssef Botros, MD; Ariy Volfson, MD. P0303 - DARK SIDE OF THE ESOPHAGUS. Program No. P0303. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.