Esophageal xanthoma: Report of two cases and a review of the literature

Abstract

So far, three cases of esophageal xanthoma have been reported. We describe here endoscopic, microscopic and immunohistochemical findings of two new cases of this rare condition, and a review of five cases of esophageal xanthoma, including our cases. Esophageal xanthomas endoscopically show yellow granular spots or a slightly elevated lesion, and are similar to an ectopic sebaceous gland. Microscopically, an aggregate of foamy histiocytes (lipid islands) is seen immediately beneath the squamous epithelium, particularly between the rete ridges. Immunohistochemically, xanthoma cells are positive for CD68, which indicate a histiocytic origin. The etiology of esophageal xanthoma remains unclear. We emphasize that esophageal xanthomas may have been erroneously diagnosed as an ectopic sebaceous gland on endoscopic examination.

Non-gastric Gastrointestinal Xanthomas: Case Series and Literature Review

“…Outside the GI tract, xanthomas are more frequent in soft tissues and skin. However, their histopathological features are identical regardless of location [3].…”

“…They have not been reported frequently in the literature [2]. Originally termed "lipoidinseln", more recently these lesions are named xanthelasma or xanthoma [3,4]. They are commonly seen in patients with dyslipidemia or other conditions such as previous chemotherapy, radiotherapy, and infection [disseminated mycobacterium avium intracellulare (MAI) and cytomegalovirus (CMV) colitis] in immunosuppressed patients (AIDS) [5].…”

“…Endoscopy shows small (1-2 mm) single or multiple yellow, orange or white well-demarcated sessile macules with irregular outlines that rarely exceed 5 mm [3]; larger lesions J Gastrointestin Liver Dis, September 2016 Vol. 25 No 3: 389-394 may be nodular and elevated [1].…”

“…25 No 3: 389-394 may be nodular and elevated [1]. Microscopically, they are composed of compactly aggregated nests of large periodic acidSchiff (PAS)-negative round cells with small nuclei and foamy cytoplasm [3]. Most cells are histiocytes, although plasma cells, smooth muscle cells and Schwann cells may contribute to the whole picture [6].…”

“…Biliary reflux could be an important etiological factor [1]. Mucosal damage has been presumed to play a major role in their pathogenesis as it produces lipid-containing debris, which are eventually phagocytized by histiocytes forming foam cells [3]. This theory would explain why gastric xanthomas appear to be more frequent than esophageal xanthomas, as traumatism and inflammation may be better tolerated by esophageal squamous epithelium than by gastric columnar epithelium [2].…”