The correct answer is C: Lymphocytic esophagitis (LyE). Histopathology showed well-differentiated squamous epithelium with dense intraepithelial lymphocytic infiltration of the peripapil- lary fields without neutrophilic or eosinophilic granulocytes. Focally there were areas with peripapillary intercellular edema/spongiosis (Figure B). There were CD3+/CD4+/CD8+ lymphocytes, without
clear predominance of CD4+ or CD8+ lymphocytes (Figures C and D). Upon
re-evaluation of the esophageal biopsies from the index endoscopy, neutrophilic granulocytes were reclassified as lymphocytes with shape alterations.
Histopathology was diagnostic of LyE on both occasions.
The histologic findings of LyE were described in 20061 as abundant intraepithelial lymphocytes in the peripapillary fields of esophageal squamous
mucosa with only rare neutrophils and/or eosinophils present. There are reports on associations with reflux, hypothyroidism, Crohn’s disease, allergies,
and asthma,1, 2 but published reports are not unanimous. 2, 3 The etiology of
LyE remains unknown. There is a wide age distribution and no clear gender
predominance. The course of LyE is considered to be chronic but benign. 2
Endoscopic findings suggestive of eosinophilic esophagitis, such as rings, are
observed in 33.6% of LyE patients. 3 Presenting symptoms are most often
dysphagia or related to reflux. Treatment is symptomatic with proton-pump
inhibitor or balloon dilatation of strictures.
The patient’s dysphagia had improved 3 months following balloon dilation. She declined further follow-up. n
1. Rubio, C.A., Sjodahl, K., Lagergren, J. Lymphocytic esophagitis: A histologic subset of chronic
esophagitis. Am J Clin Pathol. 2006;125:432-7.
2. Cohen, S., Saxena, A., Waljee, A.K., et al. Lymphocytic esophagitis: A diagnosis of increasing
frequency. J Clin Gastroenterol. 2012;46:828-32.
3. Haque, S., Genta, R.M. Lymphocytic oesophagitis: Clinicopathological aspects of an emerging
condition. Gut. 2012;61:1108-14.
This article has an accompanying continuing medical education activity, also eligible for MOC credit (see Gastroenterology website for details).
Learning Objective: Upon completion of this teaching case and questions,
the learners will be able to identify one typical clinical and endoscopic presentation of the entity lymphocytic esophagitis, distinguish its histological
pattern from other esophageal disorders, and recognize a variety of other
clinical presentations of this condition.
The Answer // From page 3