Click
on thumbnails to see full sized pictures.Gastrointestinal Pathology- Clinicopathologic Correlation in Mucosal Biopsy
Case #10 (question #14 and #15):
A 33 year-old gentleman with intermittent dysphagia and “ringed esophagus” on endoscopy. Biopsy was performed from the mid-esophagus. Representative images are illustrated below:
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Question No. 14. The Answer is: (C) Eosinophilic esophagitis.
Discussion: The clinical findings (a young man with symptoms of dysphagia and “ringed esophagus “ on endoscopy) together with a biopsy showing prominent eosinophils in the esophageal epithelium from mid-esophagus is most consistent with eosinophilic esophagitis. It occurs more frequently in young men with dysphagia and allergies (M:F ~ 4:1). Esophageal rings are common endoscopic findings. While it has been described in association with eosinophilic gastroenteritis, in most reports it is limited to esophagus. An association with allergies is common. Reflux, fungal or parasitic infection must be excluded.
Question No. 15. The Answer is: (D) Eosinophilic infiltration tends to be found in distal esophagus.
Discussion: In contrast to reflux esophagitis, the upper and mid esophagus in eosinophilic esophagitis are usually involved with sparing of the distal part. Eosinophilic infiltration is present deep in the esophageal wall and not just limited to mucosa in eosinophilic esophagitis. Importantly the distinction has clinical implications as patients with eosinophilic esophagitis tend to respond to steroids dramatically.