Abstract
We report the case of a 63-year-old man who underwent annual surveillance esophagogastroduodenoscopy, during which a small squamous cell carcinoma and a tiny yellowish granular lesion were found in the middle esophagus, slightly apart from each other. Magnifying endoscopy with narrow-band imaging of the yellowish granular lesion showed yellowish spots and blots scattered within an approximately 2-mm area. The larger spots appeared nodular and were overlaid with tortuous microvessels. Subsequently, both the lesions were excised en masse via endoscopic submucosal dissection, and the yellowish lesion was determined to be xanthoma. Histologically, an aggregated nest of foam cells surrounded by intrapapillary capillary vessels filled the intraepithelial papillae; the foam cells also extended inferiorly, below the rete ridges, and were sparsely distributed through the lamina propria mucosae. To our knowledge, the latter finding is the first to be described in literature, which leads us to postulate that the number of foam cells in the lamina propria mucosae may affect how thick and yellow a xanthoma appears on endoscopy. We believe that this case that presents a highly detailed comparison between endoscopic and histologic findings improves our understanding of the endoscopic appearance of esophageal xanthomas and may facilitate a precise diagnosis of this rare disease.
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References
Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O, et al. Xanthelasmas of the upper gastrointestinal tract. J Gastroenterol. 2004;39:215–9.
Remmele W, Engelsing B. Lipid island of the esophagus. Case Rep Endosc. 1984;16:240–1.
Vimala R, Ananthalakshmi V, Murthy M, et al. Xanthelasma of esophagus and stomach. Indian J Gastroenterol. 2000;19:135.
Herrera-Goepfert R, Lizano-Soberon M, Garcia-Perales M. Verruciform xanthoma of the esophagus. Hum Pathol. 2003;34:814–5.
Hirokawa M, Takenaka R, Takahashi A, et al. Esophageal xanthoma: report of two cases and a review of the literature. J Gastroenterol Hepatol. 2003;18:1105–8.
Licci S, Campo SM, Ventura P. Verruciform xanthoma of the esophagus: an uncommon entity in an unusual site. Endoscopy. 2010;42:E330.
Becheanu G, Dumbrava M, Arbanas T, et al. Esophageal xanthoma–report of two new cases and review of the literature. J Gastrointest Liver Dis. 2011;20:431–3.
Min KW, Koh JS, Lee KG, et al. Verruciform xanthoma arising in the mid esophagus. Dig Endosc. 2012;24:387.
Salamanca J, Alemany I, Sosa G, et al. Esophageal verruciform xanthoma following radiotherapy. Gastroenterol Hepatol. 2012;35:317–20.
Park HS, Jang KY, Moon WS. Incidental esophageal xanthoma in a patient with ileocecal lymphoma. Dig Endosc. 2013;25:92–3.
Bang CS, Kim YS, Baik GH, et al. Xanthoma of the esophagus. Clin Endosc. 2014;47:358–61.
Dirweesh A, Khan M, Bukhari S, et al. Nodular esophageal xanthoma: a case report and review of the literature. Case Rep Gastrointest Med. 2017;2017:1503967.
Uehara K, Iwashita H, Tanabe Y, et al. Esophageal xanthoma: presence of M2 macrophages suggests association with late inflammatory and reparative processes. Open Med (Wars). 2017;12:335–9.
Hamada K, Yamasaki Y, Kubota J, et al. Gastrointestinal: the first report of an esophageal xanthoma in the cervical inlet patch. J Gastroenterol Hepatol. 2018;33:1938.
Hamada K, Uedo N, Kubo C, et al. Endoscopic appearance of esophageal xanthoma. Endosc Int Open. 2019;7:E1214–20.
Hamada K, Yamasaki Y, Kubota JI, et al. Yellowish lesions in the oesophagus. Gut. 2019;68:39–158.
Mori H, Kato M, Uraoka T. A case of esophageal xanthoma with epithelial reactive inflammation with a characteristic finding of narrow-band imaging magnifying endoscopy. Dig Dis. 2020;38:85–8.
Noguchi H, Kitazono I, Hamada K, et al. Verruciform xanthoma of the esophagus: two case reports with review of the literature. Int J Surg Pathol. 2020;28:302–5.
Yang XY, Fu KI, Chen YP, et al. Diffuse xanthoma in early esophageal cancer: a case report. World J Clin Cases. 2021;9:5259–65.
Oyama T, Inoue H, Arima M, et al. Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society. Esophagus. 2017;14:105–12.
Fujita Y, Kishimoto M, Dohi O, et al. How to adjust endoscopic findings to histopathological findings of the stomach: a “histopathology-oriented” correspondence method helps to understand endoscopic findings. Gastric Cancer. 2018;21:573–7.
Hamada K, Takeuchi Y, Kubo C, et al. Sporadic minute pharyngeal xanthomas detected incidentally during esophagogastroduodenoscopy: a case series. Head Neck Pathol. 2019;13:277–80.
Hamada K, Tanaka T, Kawahara Y, et al. Pharyngeal xanthoma detected during EGD screening. Gastrointest Endosc. 2019;90:521–2.
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Mannami, T., Sakaki, T., Tanaka, T. et al. Esophageal xanthoma with nearby coexistent squamous cell carcinoma observed using magnifying endoscopy with narrow-band imaging. Clin J Gastroenterol 15, 325–332 (2022). https://doi.org/10.1007/s12328-021-01583-4
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DOI: https://doi.org/10.1007/s12328-021-01583-4