Endoscopic appearance of esophageal xanthoma

Abstract

Background and study aims Esophageal xanthomas are considered to be rare, and their endoscopic diagnosis has not been fully elucidated. The aim of the present study was to determine the characteristics of the endoscopic appearance of esophageal xanthomas.

Patients and methods This was a retrospective study of consecutive patients with histologically diagnosed esophageal xanthomas at a referral cancer center in Japan. The endoscopic appearance, by magnifying or image-enhanced endoscopy, and histological findings of esophageal xanthomas were investigated.

Results Seven patients (six men and one woman) were enrolled. All of the patients had a solitary lesion, and the median size was 2 mm (range, 1 – 5 mm). Conventional white-light endoscopy showed the lesions as flat areas with yellowish spots in four cases and slightly elevated yellowish lesions in three cases. Magnifying endoscopy, performed in six patients, revealed the lesions as areas with aggregated minute yellowish spots with tortuous microvessels inside. Magnifying narrow-band imaging contrasted the yellowish spots and microvessels better than white-light endoscopy. In all lesions, histological examination showed that the yellowish spots corresponded to papillae filled with foam cells. The foam cells were strongly immunopositive for CD68, and in all lesions, CD34-positive intrapapillary capillaries surrounded the aggregated foam cells. The different morphologies of the flat and slightly elevated lesions corresponded to different densities of papillae filled with foam cells.

Conclusions Magnifying endoscopy revealed minute yellowish spots with tortuous microvessels inside. These correspond well with histological findings and so may be useful in the diagnosis of esophageal xanthomas.

• References

• 1 Stiff KM, Cohen PR. Vegas (verruciform genital-associated) xanthoma: a comprehensive literature review. Dermatol Ther (Heidelb) 2017; 7: 65-79
• 2 Sekikawa A, Fukui H, Sada R. et al. Gastric atrophy and xanthelasma are markers for predicting the development of early gastric cancer. J Gastroenterol 2016; 51: 35-42
• 3 Kimura K, Hiramoto T, Buncher CR. Gastric xanthelasma. Arch Pathol 1969; 87: 110-117
• 4 Remmele W, Engelsing B. Lipid island of the esophagus. Case report. Endoscopy 1984; 16: 240-241
• 5 Vimala R, Ananthalakshmi V, Murthy M. et al. Xanthelasma of esophagus and stomach. Indian J Gastroenterol 2000; 19: 135
• 6 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: 1105-1108
• 7 Herrera-Goepfert R, Lizano-Soberón M, García-Perales M. Verruciform xanthoma of the esophagus. Hum Pathol 2003; 34: 814-815
• 8 Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O. et al. Xanthelasmas of the upper gastrointestinal tract. J Gastroenterol 2004; 39: 215-219
• 9 Licci S, Campo SM, Ventura P. Verruciform xanthoma of the esophagus: an uncommon entity in an unusual site. Endoscopy 2010; 42 (Suppl. 02) E330
• 10 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: 431-433
• 11 Min KW, Koh JS, Lee KG. et al. Verruciform xanthoma arising in the mid esophagus. Dig Endosc 2012; 24: 387
• 12 Salamanca J, Alemany I, Sosa G. et al. Esophageal verruciform xanthoma following radiotherapy. Gastroenterol Hepatol 2012; 35: 317-320
• 13 Park HS, Jang KY, Moon WS. Incidental esophageal xanthoma in a patient with ileocecal lymphoma. Dig Endosc 2013; 25: 92-93
• 14 Bang CS, Kim YS, Baik GH. et al. Xanthoma of the esophagus. Clin Endosc 2014; 47: 358-361
• 15 Díaz Del Arco C, Álvarez Sánchez Á, Fernández Aceñero MJ. Non-gastric gastrointestinal xanthomas: case series and literature review. J Gastrointest Liver Dis 2016; 25: 389-394
• 16 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: 335-339
• 17 Hamada K, Yamasaki Y, Kubota JI. et al. Yellowish lesions in the oesophagus. Gut 2019; 68: 39-158
• 18 Secretan B, Straif K, Baan R. et al. A review of human carcinogens – Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol 2009; 10: 1033-1034
• 19 Hamada K, Takeuchi Y, Kubo C. et al. Sporadic minute pharyngeal xanthomas detected incidentally during esophagogastroduodenoscopy: a case series. Head Neck Pathol 2019; 13: 277-280
• 20 Hamada K, Tanaka T, Kawahara Y. et al. A pharyngeal xanthoma detected during esophagogastroduodenoscopy screening. Gastrointest Endosc 2019; DOI: 10.1016/j.gie.2019.04.221. [Epub ahead of print]
• 21 Harris L, Staines K, Pring M. Oral verruciform xanthoma. BMJ Case Rep 2015; 2015: bcr2014209216