Sebaceous Glands in the Esophagus (Fordyce's Spots): A Rare, Benign and Enigmatic Lesion. Study of 9 Cases and Review of Literature

Document Type

Conference Proceeding

Publication Date

3-2018

Publication Title

Laboratory Investigation

Abstract

Background: Ectopic sebaceal glands (ESG), also known as Fordyce spots, are well known histologic entity in mucosal surfaces. However, ESG in esophagus is extremely rare with currently < 50 cases described in English literature. We present 9 additional cases making this the largest case series. Design: Retrospective review of 9 cases diagnosed over a 14 year period (2001-2015). Cases were searched for terms “sebaceal” and “sebaceous” in esophageal biopsies, resections and autopsy cases. Clinical history, endoscopic findings and pathologic features were analyzed. Results: The mean age was 55 years, and ESG was identified in similar frequency in both sexes. The patients underwent EGD for various reasons, including dyspepsia, epigastric pain, iron deficiency anemia and GERD. On the EGD, occasionally yellow-white patchy submucosal areas in the esophagus were identified. Biopsy pathology showed lobules of benign ectopic sebaceous glands within the squamous epithelium and in the underlying lamina propria. Concomittant esophagitis was identified in 4 cases. The ESG were composed of vacuolated, lipid-filled cells, and did not demonstrate any atypical features. The lobules were commonly grouped in groups of 2 up to 5 in one unit, and did not exceed more that 3 mm in size. One case had lobules associated with rudimentary hair follicle. We did not identify any sebaceous glands in other locations like the stomach or duodenum. Conclusions: Ectopic sebaceal glands (ESG) in the esophagus are a benign entity and usually are discovered incidentally, although a third of patients presented with failure to respond to GERD treatment. Due to the lack of upper gastrointestinal tract screening in the United States, the incidence in the general population cannot be determined. Therefore, ESG are most likely to found in association with dyspepsia, GERD and epigastric pain. A single Korean study reported a prevalence rate of of 0.05% in a systematically screened asymptomatic population. Histological confirmation is essential for definitive diagnosis, since it is endoscopically indistinguishable from other entities such as xanthomas, candidiasis, glycogenic acanthosis and papillomas. The etiology for this has been widely postulated with most authors believing this to be either benign metaplasia of salivary or submucus glands and others favoring this to be ectopic tissue. This difference between ectopic versus metaplastic cannot be definitively ascertained due to the endodermal origin of both and lack of supportive data.

Volume

98

Issue

Suppl 1

First Page

264

Comments

United States and Canadian Academy of Pathology (USCAP) 107th Annual Meeting, March 17-23, 2018, Vancouver, BC, Canada

Last Page

265

DOI

10.1038/labinvest.2018.9

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