A common oesophageal finding?

This was found in the distal oesophagus of a patient with dyspepsia. You take some samples. 
WHAT WILL YOU TELL THE PATIENT?

■ This is a benign finding

Yes it is but do you know what it is?

■ We'll see what biopsies show

It's' a spot diagnosis!

■ This may well need EMR

Very unlikely unless those IPCL's look odd

■ Staging investigations are likely next

Can't imagine!

explanation

This may be a good example of 'we don't see' because we don't know what it is. Intuitively, we all blank this because it's a benign finding. But what is it?  It's actually a patch of squamous hyperkeratosis with some underlying basal cell hyperplasia. The normal squamous basal cell layer is 1-4 cells thick but, in reflux oesophagitis thic increase up to 75% of the epithelial thickness. However, many cases of reflux oesophagitis does not exhibit basal cell hyperplasia and conversely, there are cases which will not be due to reflux disease as in this case!  

In rodents (!), the finding has been linked with vitamin deficiencies and zinc deficiency.  Of course, squamous hyperkeratosis in the mouth is associated with squamous neoplasia [ J Clin Pathol 2005;58:1325–1327 ] and for this reason, I always take some samples.  However, I am yet to find a single case of dysplasia within a patch of oesophageal squamous hyperkeratosis !!!