Читать книгу Gastrointestinal Pathology - Группа авторов - Страница 67

The histologic appearance of EOE is not specific, and mucosal infiltration by eosinophils is a component of a variety of other esophageal inflammatory conditions (Table 2.4).

GERD and PPI‐responsive esophageal eosinophilia exhibit considerable histologic overlap with EOE. In an untreated patient, fewer numbers of eosinophils with distal predominance may be suggestive of GERD. Correlation with response to PPI therapy is paramount.

In eosinophilic gastroenteritis, obtaining biopsy specimens from the stomach and duodenum and other clinical symptoms such as nausea, vomiting, and diarrhea may be helpful in establishing a diagnosis.

The presence of granulomas is helpful in diagnosing esophageal involvement by Crohn’s disease, but they are uncommon. Eosinophils may also be admixed with neutrophils and lymphocytes, and involvement of other parts of the GI tract is typically present.

Infections are recognized by the identification of viral inclusions (such as HSV), and fungal or parasitic organisms. Mixed inflammation with neutrophils may also be present. Rare cases of HSV esophagitis occurring in a background of EOE have been described.

Table 2.4 Endoscopic and histologic features of the major causes of infectious esophagitis.

Organism	Endoscopic features	Morphological features	Ancillary studies
Candida	Focal or confluent white plaques	Parakeratosis with neutrophils Colonization of ulcers Budding yeast, pseudohyphae, occasional septate hyphae Superficial invasion typical	PAS‐diastase, GMS stains
Herpes simplex	Superficial ulcers, multiple	Edge of ulcer—inclusions in squamous cells and/or squamous debris of ulcer slough Multinucleation, ground glass nuclei, dense eosinophilic nuclear inclusions (Cowdry type A)	IHC
CMV	Single deep ulcer, linear ulcers	Base of ulcer—inclusions in endothelial and stromal cells Intranuclear (“owl's eye”) and granular cytoplasmic inclusions Atypical inclusions common	IHC

Table 2.5 Conditions associated with esophageal eosinophilia in the differential diagnosis of EOE.

GERD

PPI‐responsive esophageal eosinophilia

Eosinophilic gastrointestinal diseases

Crohn's disease

Infection (Candida, HSV, parasites)

Hypereosinophilic syndrome

Achalasia

Drug hypersensitivity injury

Vasculitis

Pemphigus

Connective tissue diseases

Graft versus host disease (GVHD)

In drug‐induced esophageal eosinophilia, there is a temporal relationship and resolution when the offending agent is withdrawn.