Endoscopy Challenge #5 - March '12

Answer: Eosinophilic granuloma

Pathology reading: squamous epithelium with patchy increase in intraepithelial eosinophils, focal eosinophilic micro abscesses and focally prominent intraepithelial lymphocytes (Image 2). Esophageal granulomas in the esophagus are rare in the literature. Eosinophilic granulomas have been sparsely reported in the stomach and duodenum of individuals with background allergic disorders or parasites [1-3]. Sizes can vary greatly and have been confused with malignant lesions. Gastric lesions are usually noted as ulcerated, while duodenal lesions are nodular in appearance. A review of the histologic characteristics of eosinophilic granulomas notes that eosinophilic cell infiltration is common, as is a generous hyperplasia of arterioles and venules in these patients [4]. These features were all noted in this case.

Image 2

Authors and References