Yellowish lesions in the oesophagus

Abstract

Clinical presentationA 51-year-old man, who had no previous disease, underwent a screening oesophagogastroduodenoscopy, which revealed multiple yellowish lesions in the middle thoracic oesophagus. All lesions were ≤3 mm in size and slightly elevated. Each lesion showed one or two white protrusions on the surface (figure 1). We observed that one lesion looked obviously different from the others and showed yellowish granular spots (figure 2). A biopsy was performed on a representative lesion among the slightly elevated yellowish lesions with white protrusions (figure 3). A biopsy was repeated on a lesion showing yellowish granular spots (figure 4). Blood tests which were examined on the same day, including triglyceride and cholesterol, were within normal limits. Figure 1Slightly elevated yellowish lesions with white protrusions in the middle thoracic oesophagus. Figure 2A lesion showing yellowish granular spots in the middle thoracic oesophagus.QuestionWhat is the diagnosis?

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.…”

“…In this regard, esophageal xanthoma is speculated to be a high risk marker for the development of esophageal or head and neck cancers, in the same way that gastric xanthoma is suggested to be a high risk marker for gastric cancers 2 . According to previous case reports of esophageal xanthoma, 10 of 15 patients were men 4 5 6 7 9 10 11 12 13 14 15 16 17 . Similarly, in the present study, the lesions were detected mainly in men.…”

“…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.…”