A Rare Case of Esophageal Fordyce Spots (EFS) or Ectopic Esophageal Sebaceous Glands (EESG)

ABSTRACT

Ectopic esophageal sebaceous glands are rare, benign lesions that may mimic more serious pathology. Recognition of this condition can prevent unnecessary interventions, guide management focused on symptom control, and provide reassurance to patients.

1. Case Image

We present the case of an 83‐year‐old man who presented to our hospital for evaluation of hoarseness and sore throat. He denied heartburn, dysphagia, odynophagia, weight loss, or recent use of antibiotics or corticosteroids. There was no history of alcohol or tobacco use, and the physical examination was unremarkable.

An esophagogastroduodenoscopy (EGD) was performed, as the patient's symptoms were initially attributed to gastroesophageal reflux disease (GERD). EGD revealed multiple yellow nodular lesions in the proximal and mid esophagus, along with waxy plaques resembling glycogenic acanthosis (Figure 1A,B). Biopsies demonstrated squamous mucosa with ectopic esophageal sebaceous glands (EESG) and no dysplasia (Figure 1C,D). The patient was treated with acid suppressive therapy for presumed reflux and reported complete symptom resolution at a 2‐month follow‐up.

FIGURE 1.

(A, B) Endoscopic images demonstrating EFS in the middle third of the esophagus (yellow arrowheads), resembling benign glycogenic acanthosis. (C) Hematoxylin and eosin–stained section at 40× magnification showing squamous epithelium without associated hair follicles, supporting the ectopic nature of the lesions. (D) Hematoxylin and eosin–stained section at 400× magnification revealing sebaceous glands (blue arrowhead).

2. Discussion

Esophageal Fordyce Spots (EFS), or Ectopic Esophageal Sebaceous Glands (EESG), are rare and benign lesions that are found within the esophageal mucosa. They were first described by John Addison Fordyce in 1896 as ectopic sebaceous granules occurring in non‐sebaceous sites such as the oral cavity, orbits, palms, and genitalia [1]. The pathogenesis of EFS/EESG remains unclear, though two main hypotheses have been proposed. The heterotopia theory suggests congenital misplacement of ectodermal tissue, whereas the metaplasia theory proposes that sebaceous glands arise later in life due to chronic irritation or hormonal influence [2]. The latter theory is supported by the higher prevalence of EESG in older adults and its possible association with chronic GERD, as seen in our patient.

Although benign, EFS/EESG can mimic other esophageal lesions including glycogenic acanthosis, candidiasis, xanthomas, or neoplasms; therefore, biopsy with histopathologic confirmation is crucial for accurate diagnosis [1, 2]. Esophageal epidermoid metaplasia (EEM) should also be considered in the differential diagnosis, as it can histologically mimic skin epidermis. EEM typically presents in the mid to distal esophagus and is strongly associated with chronic mucosal irritation from tobacco and alcohol intake. Unlike EESG, EEM is a premalignant condition with the potential for progression to squamous cell carcinoma. Distinguishing EESG from EEM is therefore essential, as the latter may warrant surgical resection of the affected tissue [3].

Data on long‐term endoscopic follow‐ups are sparse, and no formal surveillance guidelines exist. Some suggest that repeat EGD every 6–12 months demonstrates lesion stability over time, with no significant changes in size or number. Importantly, no cases of malignant transformation of EFS have been reported, supporting a favorable prognosis [1, 2]. Increasing awareness of EFS/EESG can help avoid unnecessary interventions and provide reassurance to both patients and providers.

Author Contributions

Shreya Bollu: writing – original draft, writing – review and editing. Sugandha Bollu: writing – original draft, writing – review and editing. Srikrishna Bollu: writing – original draft, writing – review and editing. Amy Yeung: writing – original draft, writing – review and editing. Elizabeth Eapen: validation, visualization. Metin Taskin: validation, visualization. Janardhan Bollu: supervision, validation, visualization. Sita Chokhavatia: supervision, validation.

Funding

The authors have nothing to report.

Ethics Statement

The authors have nothing to report.

Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Conflicts of Interest

The authors declare no conflicts of interest.

Bollu S., Bollu S., Bollu S., et al., “A Rare Case of Esophageal Fordyce Spots (EFS) or Ectopic Esophageal Sebaceous Glands (EESG),” Clinical Case Reports 14, no. 2 (2026): e71940, 10.1002/ccr3.71940.

Data Availability Statement

No datasets were generated or analyzed during this manuscript. All information presented in this manuscript is contained within the article itself.