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Yeom and Ryu: Ectopic Sebaceous Gland in Esophagus Presenting as Subepithelial Tumor
Images in Clinical Medicine

Chonnam Medical Journal 2019; 55(3): 168-169.

Published online: 24 September 2019

DOI: https://doi.org/10.4068/cmj.2019.55.3.168

Ectopic Sebaceous Gland in Esophagus Presenting as Subepithelial Tumor

Dong Han Yeom, Han Seung Ryu

Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea.

Corresponding Author: Han Seung Ryu. Department of Internal Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea. Tel: +82-63-859-2670, Fax: +82-63-855-2025, hanseung@wonkwang.ac.kr

Received 12 June 2019       Revised 3 July 2019       Accepted 4 July 2019

© Chonnam Medical Journal, 2019

Chonnam Medical Journal

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A 64-year-old man was referred to our hospital for a routine medical examination. His past medical history revealed only essential hypertension. He was an ex-smoker and a social drinker. Physical examination was unremarkable. His blood and serum test results were within normal limits. Upper gastrointestinal endoscopy showed a slightly yellow flat nodule mimicking a subepithelial tumor located in the lower esophagus (about 5 cm above the gastroesophageal junction) (Fig. 1). The endoscopic biopsy specimen showed benign acanthosis. The rest of the stomach and duodenum revealed no abnormalities except for mild erythematous gastritis. We performed precutting endoscopic mucosal resection (EMR) with partial circumferential incision after sufficient submucosal injection for diagnostic purposes.
Histopathological examination revealed that some lobules of sebaceous glands were located in the deep portion of lamina propria slightly infiltrated by inflammatory cells. No hair follicles were observed, and there was no evidence of malignancies (Fig. 2).
Sebaceous glands are normally found in association with hair follicles which are derived from the pilosebaceous apparatus. Ectopic sebaceous glands have been found in various tissues of ectodermal origin, such as the palms and soles, nipples, external genitalia, and parotid glands.1 Sebaceous glands are rarely derived from endoderm in the esophagus.23
The presence of sebaceous glands in the esophagus has not yet been completely explained. Several hypotheses have been postulated. Although both embryologic misplacement and the metaplasia of esophageal submucosal mucus glands or squamous epithelium have been proposed, it seems more likely that sebaceous glands in the esophagus originate as a result of acquired metaplasia of squamous epithelium.4
The endoscopic findings may appear as yellowish papules or nodules of various sizes and numbers. A differential diagnosis is needed in the presence of other yellowish subepithelial lesions in the esophagus, such as carcinoid tumor, granular cell tumor, or xanthoma.5 Pathologic confirmation can be more important than endoscopic finding. In most cases, diagnosis is possible with endoscopic biopsy. Occasionally, endoscopic forcep biopsies are insufficient to predict final histology in a single lesion mimicking subepithelial tumor as in our case. A bite-on-bite biopsy or diagnostic EMR is needed because the ectopic sebaceous glands are located in the deep portion of lamina propria.
On the basis of what has been observed so far, ectopic sebaceous glands are entirely benign in nature, and there are no significant changes during 3 years of follow-up.6 There is still a lack of evidence to support the need for further surveillance endoscopies.

Figures and Tables

FIG. 1

Endoscopic examination reveals a slightly yellow flat nodule mimicking subepithelial tumor located in the lower esophagus.

cmj-55-168-g001
FIG. 2

Histopathological examination reveals mature lobulated sebaceous glands that overlie the esophageal squamous epithelium without hair follicles or malignancy. Inflammatory infiltration is present around the sebaceous glands located in the deep portion of lamina propria (H&E, ×40).

cmj-55-168-g002

Notes

CONFLICT OF INTEREST STATEMENT None declared.

References

1. Guiducci AA, Hyman AB. Ectopic sebaceous glands. A review of the literature regarding their occurrence, histology and embryonic relationships. Dermatologica. 1962; 125:44–63.
2. John F, Raghuraman VU, Taylor JR. Ectopic sebacious glands in the esophageal mucosa. Clin Gastroenterol Hepatol. 2012; 10:xxxii.
crossref
3. Wang WP, Wang WS, Tsai YC. Multiple tiny ectopic sebaceous glands discovered throughout entire esophageal tract. Dig Dis Sci. 2009; 54:2754–2757.
crossref
4. Nakanishi Y, Ochiai A, Shimoda T, Yamaguchi H, Tachimori Y, Kato H, et al. Heterotopic sebaceous glands in the esophagus: histopathological and immunohistochemical study of a resected esophagus. Pathol Int. 1999; 49:364–368.
crossref
5. Jeon MS, Kim GH, Jeong DY, Park BK, Lee MW, Lee SJ, et al. Magnifying endoscopy for esophageal ectopic sebaceous glands. Clin Endosc. 2018; 51:495–497.
crossref
6. Fukuchi M, Tsukagoshi R, Sakurai S, Kiriyama S, Horiuchi K, Yuasa K, et al. Ectopic sebaceous glands in the esophagus: endoscopic findings over three years. Case Rep Gastroenterol. 2012; 6:217–222.
crossref
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