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Oesophageal sebaceous heterotopia with ducts mimicking epidermoid metaplasia: a rare diagnostic pitfall
  1. Audrey McCloskey1,
  2. Kevin M Waters1,
  3. Brent K Larson1,
  4. Maha Guindi1,
  5. Keith Lai1,
  6. Srinivas Gaddam2,
  7. Anila Vasireddy3,
  8. Danielle A Hutchings1
  1. 1Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2Karsh Dvision of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
  3. 3Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA
  1. Correspondence to Dr Danielle A Hutchings; danielle.hutchings{at}cshs.org

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Sebaceous heterotopia is a rare finding in the oesophagus with a prevalence of 0.05%.1 It is thought to represent a metaplastic process and is benign requiring no special clinical follow-up.2 3 Histologically, oesophageal sebaceous heterotopia (ESH) is characterised by lobules of sebaceous glands in the lamina propria, which lack an associated hair follicle. The glands may have associated excretory ducts and demonstrate a connection to the luminal surface through a channel lined by keratinising squamous epithelium with a granular cell layer resembling the epithelium of the follicular infundibulum in the skin.

Oesophageal epidermoid metaplasia (EEM) is another rare lesion. However, in contrast to ESH, EEM most likely represents a preneoplastic process, as it has been associated with synchronous and metachronous squamous dysplasia and carcinoma.4–7 Patients with EEM frequently have risk factors for squamous neoplasia, including significant exposure to tobacco and/or alcohol. Clinical management of EEM may include shorter interval endoscopic surveillance or endoscopic resection of lesion(s). EEM appears histologically as a discrete, sharply defined lesion characterised by epithelial hyperplasia, a prominent granular cell layer and superficial hyperorthokeratosis.4

ESH and EEM are biologically distinct lesions that share similar morphological features, namely keratinising squamous epithelium with a granular cell layer, which could potentially present diagnostic difficulty on small, fragmented biopsies. We examined the clinicopathological features of ESH in a single institutional cohort of 14 patients, the largest case series to date and sought to identify any distinguishing characteristics or pitfalls in the differential diagnosis with EEM.

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Footnotes

  • Handling editor Vikram Deshpande.

  • X @None

  • Contributors AM and DAH designed the study, collected data, reviewed histopathology slides and wrote the manuscript. KMW, BKL, MG, KL, SG and AV discussed results and contributed to the final version of the manuscript. DAH is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.