Esophageal lesions in myeloproliferative neoplasms.

A 67-year-old man was admitted to our hospital with worsening odynophagia. He had been diagnosed as having chronic neutrophilic leukemia based on excessive neutrophilia without blasts, anemia, hyperplastic bonemarrowwith normal neutrophilic maturation, and hepatosplenomegaly, without bcr/abl rearrangement [1]. Finally, he was rediagnosed as having myeloproliferative neoplasm (MPN), unclassifiable, according to the 2008 World Health Organization (WHO) classification [2]. In the 2 years after the diagnosis was made he was treated with hydroxyurea, interferon-alpha, Ara-C, and then VP-16. Laboratory studies revealed leukocytosis (15.4×109/L, 69% mature neutrophils) without blasts, anemia (hemoglobin 10.2g/dL), and thrombocytosis (569×109/L). Fluoroscopy revealed several longitudinal ulcers in the middle to lower esophagus (●" Fig.1). Esophagogastroduodenoscopy showed multiple longitudinal and aphthoid ulcers (●" Fig.2). There were not specific lesions in the stomach, duodenum, and colorectum. Histological examination revealed an intense infiltration of polymorphic neutrophils (mimicking the neoplastic cells detected in the bone marrow) in the mucosa as well as the vascular wall (●" Fig.3), indicating neoplastic cell infiltration to esophagus. Prednisolone 20mg daily was prescribed in addition to VP-16, resulting in improvement of the esophageal lesions (●" Fig.4). Esophageal manifestations in leukemic patients include hemorrhagic lesions, leukemic infiltrates, and pseudomembranous and fungal esophagitis [3,4]. Although esophageal involvement was reported in 7.2% of 207 autopsied cases Fig.1 Upper gastrointestinal barium study of a 67-year-old man with worsening odynophagia showing several longitudinal ulcers in the middle to lower esophagus. Fig.2 Esophagogastroduodenoscopy showed multiple (a) longitudinal and (b) aphthoid ulcers, but no surrounding redness, white coat, or raised plaques in relation to the ulcers.