Description
A 44-year-old woman presented with dyspeptic symptoms for 2-year duration. In view of persistent symptoms, she underwent an upper gastrointestinal tract endoscopy, which revealed multiple elevated whitish yellow spots (1–5 mm) scattered throughout the oesophagus (figure 1). However, no growth or stricture was noted. Differential diagnosis of xanthoma, oesophageal candidiasis and metastasis were kept and biopsies were taken.
Figure 1.
Multiple whitish yellow elevated spots 1–5 mm in size scattered throughout the oesophagus.
Biopsies showed oesophageal epithelium with mild basal cell hyperplasia. Epithelium and subepithelium showed multiple lobules of polygonal cells with abundant foamy cytoplasm and small vesicular nucleus resembling mature sebocytes (figure 2). It was negative for pancytokeratin, S-100 and CD68 (not shown) excluding metastatic renal cell carcinoma and xanthoma, respectively. Androgen receptor immunostaining, specific for sebocytes, was positive thereby confirming ectopic sebaceous glands. There was no evidence of malignancy, granuloma or fibrosis.
Figure 2.
Oesophagus with lobules of mature sebocytes in the epithelium and subepithelium (red arrow pointed) (H&E mag. 400x).
Ectopic sebaceous glands have been reported in lips (Fordyce spots), eyes, palms, soles, larynx and prepuce.1 Involved sites in gastrointestinal tract are buccal mucosa, tongue, salivary glands and oesophagus. The number of lesions in oesophagus can range from single to hundreds. Patient can be asymptomatic or present with symptoms of gastro-oesophageal reflux disease.2 3
Histogenesis is hypothesised to be metaplasia of the submucosal glands. Morphological differential includes xanthoma and metastatic carcinoma.
These are benign lesions that need symptomatic treatment and reassurance. Characteristic endoscopy, histomorphology, relevant immunohistochemistry and awareness help in the diagnosis.
Learning points.
Patients’ with ectopic sebaceous glands in oesophagus can be asymptomatic or can present with dyspeptic symptoms.
Accurate histopathological diagnosis is essential as it is a benign lesion and it has varied differential diagnosis.
Awareness about this entity for gastroenterologists and endoscopists is crucial.
Footnotes
Contributors: All the authors were involved in conception and drafting of the work. BT was involved in collection of data and writing. RN was the pathology consultant who diagnosed and signed off the report. SD and SKS were involved in the clinical management of patient.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Patient consent for publication: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.
References
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