Alexander Woodcock, MD1, Brandon Garten, BS2, Raguraj Chandradevan, MD3, Humberto Sifuentes, MD3 1Augusta University Medical Center, Augusta, GA; 2Medical College of Georgia at Augusta University, Augusta, GA; 3Augusta University, Augusta, GA Introduction: Esophageal leukoplakia, characterized by a granular layer with orthokeratosis/hyperorthokeratosis, is a rare premalignant condition associated with increased risk of esophageal squamous cell carcinoma (SCC). We present a case of esophageal leukoplakia that showed histologic resolution during surveillance, raising important questions regarding disease progression and surveillance strategies.
Case Description/
Methods: A 56-year-old woman with a smoking history presented with dysphagia and weight loss. Initial EGD revealed eosinophilic esophagitis (EoE) with an eosinophil count of 40 per HPF; she was started on proton pump inhibitor (PPI) therapy. Two years later, persistent symptoms prompted repeat EGD, which showed multiple concentric rings and fibrotic mucosa. Biopsies demonstrated esophageal leukoplakia with acute esophagitis and rare eosinophils. A few months later, surveillance EGD revealed sloughed whitish plaques; biopsies showed epidermoid metaplasia and active esophagitis without dysplasia or EoE. She was enrolled in 6-month surveillance. Subsequent EGDs showed chronic inflammation with rare intraepithelial eosinophils, without leukoplakia or dysplasia. Endoscopically, the mucosa remained fibrotic and sloughed in appearance. The most recent biopsy showed benign squamous epithelium with mild inflammation and fungal organisms, which were treated. The patient remained adherent to twice-daily PPI therapy throughout. Discussion: This case underscores the diagnostic and clinical challenges in managing esophageal leukoplakia. Despite its known premalignant potential, our patient demonstrated histologic regression, though endoscopic abnormalities persisted. Preliminary genetic studies suggest that leukoplakia may represent an early precursor to squamous dysplasia. However, most SCCs arise de novo or directly from dysplastic epithelium, often bypassing identifiable leukoplakia stages. The natural history of esophageal leukoplakia may therefore parallel that of Barrett’s esophagus, where histologic improvement does not eliminate long-term malignant risk. Accordingly, we emphasize the need for ongoing endoscopic surveillance even in the setting of apparent histologic resolution.
Disclosures: Alexander Woodcock indicated no relevant financial relationships. Brandon Garten indicated no relevant financial relationships. Raguraj Chandradevan indicated no relevant financial relationships. Humberto Sifuentes indicated no relevant financial relationships.
Alexander Woodcock, MD1, Brandon Garten, BS2, Raguraj Chandradevan, MD3, Humberto Sifuentes, MD3. P2883 - Histologic Resolution of Esophageal Leukoplakia: A Case Challenging Surveillance Paradigms, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
