Esophageal Cancer, Hyperkeratosis, and Oral Leukoplakia

Abstract

A 25-YEAR-OLD woman was admitted to the hospital because of dysphagia. For six weeks she had experienced progressive lower retrosternal discomfort on swallowing. Two weeks before admission she began regurgitating food immediately after eating, at which time she could only eat soft food and liquids. There was no history of pyrosis, abdominal pain, esophagitis, or peptic ulcer disease, and the patient had not used alcohol or tobacco. 1 Although there was no family history of esophageal cancer, there was a history of hyperkeratosis in the father and in three of eight siblings, each of whom has offspring bearing this trait. Findings of a physical examination were unremarkable except for 0.5-cm hyperkeratotic nodules over her distal and proximal interphalangeal joints (tylositas articularis or knuckle pads) (Fig 1) and hyperpigmentation and hyperkeratosis (keratosis pilaris) on the upper parts of her arms. In addition, the patient had leukoplakia of the buccal mucosa. Routine