Esophageal xanthoma: presence of M2 macrophages suggests association with late inflammatory and reparative processes

Abstract

<jats:title>Abstract</jats:title><jats:p>Esophageal xanthoma is a rare lesion which is an asymptomatic small yellowish polyp, and most of the reported cases were solitary lesion. Histologically, aggregations of foam cells are found under the papillary hypertrophic squamous epithelium and the foam cells express CD68. The etiology of esophageal xanthoma is unknown. The focal irritation of the esophageal mucosa and infiltrated inflammatory cells are presumed to contribute to its pathogenesis. Although the pathogenesis may be associated with inflammation, the type and nature of the macrophages remain unclear. Here we report a 46-year-old male with esophageal xanthoma, which was incidentally found by endoscopy. Histologically, acute inflammation was not noted, and immunohistochemistry revealed that the foam cells seen in this case of esophageal xanthoma expressed increased levels of M2 macrophage markers. These findings suggest that esophageal xanthoma is associated with late inflammatory and reparative processes long after the initial inflammation of esophageal squamous epithelium.</jats:p>

Endoscopic appearance of esophageal xanthoma

“…In the present study, using non-magnifying endoscopy, four lesions were present as flat areas with yellowish granular spots and three appeared as slightly elevated yellowish lesions; median size of the lesions was 2 mm (range, 1 – 5 mm). These findings are consistent with those reported in previous articles 4 5 6 7 8 9 10 11 12 13 14 15 16 17 . Lesions presenting as flat areas with yellowish granular spots are unique, even in non-magnifying endoscopic appearance.…”

“…To the best of our knowledge, the reason why foam cells aggregate mainly in the papillae, not homogeneously in the lamina propria mucosae, is as yet unknown. However, many cases of esophageal xanthomas have shown this particular histological finding 6 7 9 11 12 13 16 17 . Moreover, xanthomas in other organs covered with squamous epithelium, such as the pharynx or oral cavity, also show the same finding 19 20 21 .…”

“…Due to their rareness, the characteristic endoscopic appearance, etiology, and clinical significance of esophageal xanthomas are not well known. Previous reports have suggested the endoscopic findings of esophageal xanthomas to be yellowish granular spots, yellowish elevated lesions, yellow-white colored plaques, or yellow verruciform lesions, measuring from 2 to 20 mm (usually ≤ 5 mm) 4 5 6 7 8 9 10 11 12 13 14 15 16 17 . However, no previous report has described the magnifying endoscopic appearance of esophageal xanthomas.…”

“…As such, endoscopic characteristics have been established within the Japanese population and the lesion is usually only diagnosed by endoscopic findings and without the use of biopsies. However, since esophageal xanthomas are rare, and only 17 cases have been described in the English literature before the present study 4 5 6 7 8 9 10 11 12 13 14 15 16 17 , endoscopic diagnosis of esophageal xanthomas have not been thoroughly investigated. In this study, therefore, using magnifying or image-enhanced endoscopy, we examined the endoscopic appearance of esophageal xanthomas which were diagnosed histologically in our hospital.…”

Dysplastic Barrett’s lesion with white opaque substance and xanthoma

“…Since then, gastric xanthelasmas have been widely reported, with a prevalence of up to 7% 8 . Esophageal xanthelasmas were first described in 1984, and since then 22 cases have been reported in the literature 9, 10. Esophageal xanthomas are rarely larger than 5 mm, and the largest reported was 20 mm 9 …”