Ectopic sebaceous glands in the esophagus

Abstract

Ectopic sebaceous glands have been recognized in many tissues of ectodermal origin. Their presence in the esophagus, an entodermal organ, is an interesting anomaly, reported only in a single autopsy series in the American literature.' This is the report of a case in life, diagnosed by fiberoptic esophagoscopy and biopsy. CASE REPORT A 44-year-old black man described symptoms suggestive of duodenal ulcer. Upper gastrointestinal radiographs revealed no abnormality. He did not complain of dysphagia or gastroesophageal reflux. He was a non-smoker and a teetotaller. Peroral endoscopy disclosed a superficial ulceration of the duodenal bulb (that later was observed to have healed completely in 6 weeks). The stomach and esophagogastric junction were normal. The esophagus was unremarkable except for multiple (more than 10), papular, oval or rounded lesions varying in size from 1 to 5 mm. Their surfaces were irregular with a yellow hue, resembling in gross appearance cutaneous xanthomas, xanthelasmas, or warts. The lesions were distributed throughout the esophagus from the level of the cricopharyngeus to the squamocolumnar junction (Figure 1). Biopsy revealed a normal squamous esophageal mucosa with sebaceous glands making up the underlying papular lesions; there was an associated nonspecific inflammatory reaction (Figure 2). Silver staining did not show argentaffin cells. The serum cholesterol, triglycerides, lipoprotein electrophoresis, fasting and 1 hour postprandial blood glucose levels were within normal limits. DISCUSSION Sebaceous glands in the lips and oral cavity recognizable as small yellow nodules are called Fordyce spots. They were originally considered as degenerative changes in the epithelium of the mucosa/-< but their true nature was subsequently recognized .5-6 Review of the original slides revealed the presence of sebaceous glands that had been earlier overlooked.'·7 Many otherwise healthy persons were found to have Fordyce spots, and they are no longer considered a rarity or a disease entity.7.8 Ectopic sebaceous glands have been detected in salivary glands, prepuce,809 vulva8 and teratomas.' A case of a benign sebaceous cyst arising from the floor of the mouth has been recorded. The presence of sebaceous glands in all these organs of ectodermal origin (or with an ectodermal element as in the teratomas) is less unusual than in the esophagus, an organ developed, in large part, from the entoderm. De la Pava and Pickren' examined by serial section the esophaguses from 20acadavers. Although the study was done