S2047 Mucosal Schwann Cell Hamartoma: A Rare Finding in the Esophagus

Abstract

Introduction: Sebaceous glands are naturally found in hair follicles but ectopic glands can be found in the orbits, oral mucosa, larynx, chest, palms, soles, and esophagus. Ectopic esophageal sebaceous glands (EESGs) are rare with an estimated incidence of 0.0046% and typically found in the lower esophagus. This case report aims to increase clinicians' awareness and recognition of ESG in the esophagus. Case Description/Methods: A 55-year-old female presented with dyspepsia which persisted in spite of treatment with PPI. She denied a history of smoking, NSAIDs, or alcohol use. Past medical history was significant for Covid-19 pneumonia requiring hospitalization and Remdesivir therapy. EGD revealed mild gastric erythema and multiple yellowish submucosal appearing, well circumscribed lesions with a prickly appearance, in the lower esophagus. Multiple mucosal biopsies of these lesions failed to provide a diagnosis and subsequently band endoscopic mucosal resection was performed. Histological evaluation revealed squamous mucosa with subepithelial sebaceous metaplasia/ectopia and mild chronic inflammation of lamina propria consistent with a diagnosis of EESG. Discussion: EESGs are benign, and it is not known if these are the result of a congenital anomaly or metaplastic change of the squamous epithelium. These are, however, benign and do not warrant further evaluation or treatment, but the diagnosis can occasionally be challenging. In the literature, these lesions are described as yellowish or whitish, flat plaques or patches, with biopsies positive for sebaceous glands. Patients can experience symptoms of gastroesophageal reflux disease or be asymptomatic. Differential diagnosis includes xanthomas, candidiasis and malignancies. Our case was unusual in that biopsies were normal, prompting further evaluation with deep mucosal resection. This is infrequently seen, as the majority of cases are confirmed with simple biopsy during EGD. Recognition of this rare finding by the endoscopist and pathologist may help prevent unnecessary work up.