Review Question - QID 213591

A 61-year-old man presents to his primary care provider for routine follow-up. The only medication the patient takes is a daily proton pump inhibitor. The patient is otherwise well but reports that he still has some symptoms of heartburn along with a chronic cough. The patient is compliant with his medication. Additionally, he continues to smoke 1.5 packs per day. On exam, his temperature is 98.4°F (36.9°C), blood pressure is 130/84 mmHg, pulse is 70/min, and respirations are 12/min. He is in no acute distress and his lung sounds are clear. His abdomen is obese, without any tenderness to palpation. The patient is referred to a specialist and an endoscopic biopsy is taken from a segment of the esophagus, as shown in Figure A. Which of the following is a concern associated with this disease?