Glycogenic acanthosis of the esophagus: radiographic and pathologic features

Evaluation of non-gastric upper gastrointestinal system polyps: an epidemiological assessment

Non-gastric upper gastrointestinal system polyps are detected rarely and mostly incidentally during upper gastrointestinal endoscopy. While the majority of lesions are asymptomatic and benign, some lesions have the potential to become malignant, and may be associated with other malignancies. Between May 2010 and June 2022, a total of 127,493 patients who underwent upper gastrointestinal endoscopy were retrospectively screened. Among these patients, those who had polyps in the esophagus and duodenum and biopsied were included in the study. A total of 248 patients with non-gastric polyps were included in this study. The esophageal polyp detection rate was 80.00/100,000, while the duodenal polyp detection rate was 114.52/100,000. In 102 patients (41.1%) with esophageal polyps, the mean age was 50.6 ± 15.1, and 44.1% (n = 45) were male. The most common type of polyps was squamous papilloma (n = 61, 59.8%), followed by inflammatory papilloma (n = 18, 17.6%). In 146 patients (58.9%) with duodenal polyps, the mean age of patients was 58.3 ± 16.5, and 69.8% (n = 102) were male. Brunner's gland hyperplasia, inflammatory polyp, ectopic gastric mucosa, and adenomatous polyp were reported to be the most prevalent types of polyps in the duodenum overall (28.1%, 27.4%, 14.4%, and 13.7%, respectively). It is crucial to identify rare non-gastric polyps and create an effective follow-up and treatment plan in the era of frequently performed upper gastrointestinal endoscopies. The epidemiological assessment of non-gastric polyps, as well as a follow-up and treatment strategy, are presented in this study.

Glycogenic Acanthosis: An Unusual Cause of Vocal Fold Leukoplakia

Glycogenic acanthosis is a common benign lesion of the esophagus; however, reports of extra-esophageal manifestations are exceedingly rare. This case represents the first report of laryngeal glycogenic acanthosis found in a living patient, presenting as vocal fold leukoplakia. Glycogenic acanthosis may be considered among the differential diagnoses of conditions presenting as vocal fold leukoplakia. Laryngoscope, 2021.

A Rare Case of Esophageal Leukoplakia: A Potential Precursor to Esophageal Malignancy

Esophageal leukoplakia or epidermoid metaplasia is a rare lesion resembling the commonly found oral leukoplakia. When found, it is typically seen incidentally on endoscopy as a white plaque but rarely it may present as a globus sensation. Histologically, it is seen as epidermal metaplasia with orthokeratosis, closely resembling the skin. Although rare, esophageal leukoplakia is precancerous and may pose a serious threat.

We present a unique case of a 61-year-old male with a history of COPD, tobacco, and alcohol dependence presenting with a six-month history of nausea and emesis resulting in poor oral intake despite having an appetite. The patient also reported weight loss. Considering his risk factors for esophageal carcinoma and alarm symptoms, an upper endoscopy was performed that revealed localized white, plaque-like mucosal changes characterized by altered texture in the lower third of the esophagus at 40cm. Biopsy results showed squamous epithelium with orthokeratosis and a prominent granular cell layer. These findings were consistent with esophageal epidermoid metaplasia. The lesion was ablated using argon plasma coagulation and radiofrequency ablation on subsequent endoscopy. The patient reported continued resolution of symptoms with each treatment session.

Esophageal leukoplakia may increase the risk for squamous cell carcinoma of the esophagus and should be followed closely. Guidelines on surveillance are yet to be established given the rarity of the disease.

Dots, lines, contours, and ends: An image-based review of esophageal pathology

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Learning Point #1: Small ulcers on esophagography are usually attributable to herpes esophagitis and drug-induced esophagitis. Although rare, Crohn’s disease may produce small apthoid ulcers. Large ulcers are usually attributable to CMV or HIV esophagitis.

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Learning Point #2: The early findings of candida are plaques that mimic glycogenic acanthosis. When plaques are seen, consider early candida or glycogenic acanthosis. When shaggy esophagus is identified, consider candidiasis.

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Learning Point #3: Varices and varicoid esophageal carcinoma may appear similar on imaging. The presence of obstruction and lack of change with time and position should sway the Radiologist to diagnosing varicoid esophageal carcinoma.

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Learning Point #4: Transverse esophageal lines should suggest the entities of feline esophagus and idiopathic eosinophilic esophagitis.

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Learning Point #5: Esophageal contour abnormalities may suggest extrinsic or intrinsic lesions. Extrinsic lesions include aberrant vessels. Intrinsic lesions include intramural pseudodiverticulosis, gastroesophageal reflux, Barrett’s esophagus, and esophageal cancer.

Esophageal pathologies encountered on fluoroscopic examination may pose a diagnostic challenge to the interpreting Radiologist. Understanding the varied imaging appearances of esophageal pathology requires a thorough understanding of barium esophagography. This article reviews the various fluoroscopic imaging findings of different esophageal pathologies by describing an approach to image interpretation centered on dots, lines, contours, and ends. By utilizing this approach, the Radiologist will be better positioned to reconcile seemingly disparate pathologies into a cogent and succinct differential diagnosis.

The relationship between reflux symptoms and glycogenic acanthosis lesions of the oesophagus

Introduction

Glycogenic acanthosis (GA) is a benign, polypoid lesion frequently seen in upper endoscopy with little known aetiology. Information about how it occurs and its clinical significance is lacking.

Aim

In this study, the relationship between GA and reflux symptoms was investigated in patients who underwent endoscopy due to reflux symptoms.

Material and methods

Sixty patients undergoing endoscopy for reflux symptoms and 60 controls without reflux symptoms were included in the study. Among the patients with reflux symptoms, two groups were formed: GA group 1 (n = 30) and non-GA group 2 (n = 30).

Results

The mean age of all patients participating in the study was 44.65 ±15.54 years; in group 1 it was 52.56 ±10.90 years and in group 2 it was 39.40 ±13.87 years. The mean age of group 1 patients was statistically significantly higher than that of group 2 patients (p < 0.05). The incidence of GA was higher in group 1 than in the control group (p = 0.001). In the reflux group, group 1 and group 2 were compared in terms of oesophagitis; group 1 had a higher incidence of oesophagitis (p < 0.05). In the reflux group, in those with GA, the risk of oesophagitis was 6.6 times higher than among those without GA (OR = 6.571; 95% CI: 2.109–20.479).

Conclusions

We think that GA is associated with advanced age, reflux disease, and oesophagitis in our study.

Glycogenic acanthosis presenting as leukoplakia on the tongue

This report describes a rare case of glycogenic acanthosis (GA) located on the tongue of a 72-year-old man. The patient presented with a white plaque that had been on the right side of the tongue for 5 years. Histologically, the lesion was characterised by thickened squamous epithelium with abundant intracellular glycogen deposits. No epithelial dysplasia was noted. This is the first report of GA involving the tongue. This benign condition should be added to the large number of lesions responsible for leukoplakia in this anatomical location.

Celiac disease and glycogenic acanthosis: a new association?

A 6-y-old boy and an 8-y-old girl were admitted to our clinic with anaemia and failure to thrive. Laboratory tests revealed iron deficiency anaemia and positive antigliadin antibodies in both of the patients. Slightly raised grey-white plaques were observed on oesophageal mucosa during endoscopical investigation of the patients. While intestinal mucosal samples confirmed diagnosis of celiac disease histologically, histopathological assessment of oesophageal lesions demonstrated glycogenic acanthosis. Since glycogenic acanthosis associated with celiac disease hasn't been reported in the literature previously to our knowledge, case reports of our patients were presented.

CONCLUSION

We suggest that glycogenic acanthosis needs to be investigated as a possible new association of celiac disease in greater paediatric series.

Benign tumors of the esophagus: radiologic evaluation

Benign tumors of the esophagus can be classified as mucosal or submucosal in origin. The most common mucosal lesions include squamous papillomas, adenomas arising in Barrett's mucosa, inflammatory esophagogastric polyps, and glycogenic acanthosis. These benign mucosal lesions can often be diagnosed on double-contrast esophagrams based on their characteristic radiographic findings. Major submucosal or intramural lesions include leiomyomas, leiomyomatosis, fibrovascular polyps, granular cell tumors, and duplication cysts. Despite their infrequency, these lesions also can often be diagnosed on esophagography and/or CT based on their characteristic radiographic findings. The purpose of this article is to review in some detail the radiographic features of these various benign tumors of the esophagus.