Question: A 74-year-old man was admitted because of progressive dysphagia to solids of 6 months duration. His past medical history was unremarkable. The patient mentioned that he had been admitted for similar complaints on 4 occasions during the last 4 years. Each time he underwent esophageal dilation with improvement of his symptoms. He denied allergies, skin problems, or any rheumatologic complaints. On physical examination, he appeared well nourished, without any signs of wasting. The laboratory data were all within reference ranges. Esophagogastroduodenoscopy (EGD) disclosed mucosal polypoid lesions covering the entire circumference of the esophageal mucosa, starting at 20 cm distance from the teeth and extending to 30 cm (Figure A). The proximal esophagus was stenosed, but the gastroscope could be advanced with minor pressure. From 30 cm to the Z-line, the mucosa seemed to be fibrosed, but no polyps were present. The remaining EGD was normal. Multiple biopsies were obtained. Histology revealed polypoid structures with multiple finger-like projections (Figure B). Further sectioning showed that the lesion consisted predominantly of broad layers of squamous epithelium, with marked hyperplasia and hypertrophy of all squamous epithelial layers (Figure C).
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