An Autopsy Case Report of Diffuse Esophageal Intramural Pseudodiverticulosis

Abstract

A case report of diffuse esophageal intramural pseudodiverticulosis (EIPD) we encountered at autopsy is described. The pseudodiverticula represented dilated excretory ducts of esophageal submucosal glands with squarnous metaplasia of the epithelium. They contained keratin flakes, mucin and/or inflammatory cells which were mainly neutrophils. Submucosal chronic inflammation surrounding the glands was prominent. The findings suggested that the ductal dilatation resulted from obstruction of the ducts by inflammatory material, mucus and desquamated epithelium. To the best of our knowledge, this is the first autopsy report of diffuse ElPD in Japan. Acta Pathol Jpn 42: 837–840, 1992.

Esophageal intramural pseudodiverticulosis (diffuse type)

“…Most investigators consider that a multifactorial process is involved with the main problem being obstruction of the duct by desquamated epithelium, mucus, inflammatory materials, and/or submucosal fibrosis. 2,3,9,12 This condition results in an inflammatory duct-dilatation of the esophageal gland, revealed as flask-shaped outpouchings on esophagograms. Thus, the chronic inflammatory cellular reactions within the esophageal mucosa may be regarded as a primary etiological agent or secondary factors in EIPD.…”

Esophageal Intramural Pseudodiverticulosis with Mallory-Weiss Syndrome: Report of a Case

“…Dysphagia was observed in 27 patients and reflux symptoms in 6, appetite loss in 1, and gastrointestinal bleeding in 1 (our case). Concomitant esophageal diseases were observed in 20 patients, including hiatal hernia (8), esophageal carcinoma (3), Barret esophagus (3), esophageal web (3), esophagitis (6), and Mallory-Weiss syndrome (1). There have been no reports of EIPD with bleeding except in our case.…”

“…The cysts and the ducts were filled with numerous inflammatory cells, desquamated epithelial cells, and mucus. 6 Based on these findings there are two etiological hypotheses about EIPD. One is that the ductal dilatation in EIPD results from an obstruction of the ducts with some inflammatory cells, desquamated epithelium, and mucus.…”

“…Some authors proposed that a Candida infection was responsible for EIPD, but now most believe that Candida is a secondary finding. 6 The histopathologic findings from the autopsy cases revealed the pseudodiverticula as dilated submucosal glands and excretory ducts. The cysts and the ducts were filled with numerous inflammatory cells, desquamated epithelial cells, and mucus.…”

Esophageal intramural pseudodiverticulosis improved by endoscopic dilatation

“…The obstruction of the opening of the esophageal mucous glands by inflammation-related increases in the viscosity of mucus, exfoliated epithelial cells, and fibrosis of mucosal and submucosal connective tissue has been reported to be a possible cause of the dilatation of the esophageal glands and the resulting formation of multiple diverticula and esophageal stenosis [8,[12][13][14][15][16][17]. The precise mechanism of the formation of esophageal stenosis in patients with EIPD is not yet understood.…”