8/2/2019 glycogenic acanthosis

1/1

1 Depa rtm en t o f Pa tho log y , H osp ita l o f th e U nive rs ity o f P en nsy lv an ia , 3400 S pru ce S t., P hilad e lp h ia , P A 1910 4 .2P resen t a dd res s : D ep ar tm en t o f R a d io lo gy , B righam and W om en s H o sp ita l, 75 F ran c is S t., B os ton , M A 02115 .3Depa rtm en t o f R a d io lo gy , M R I B ld g . 1 , H o sp ita l o f th e Un ive rs ity o f Pe nn sy lva n ia , 3 400 S pru ce S t., P h ila de lph ia , P A 191 04 . Ad d re ss co rre sp on de nce to 5 . E .

Rubes in .

96

A JR 19 95 ;16 4 :96 0 36 1 -8 03X /95 /16 41 -96 Am er ica n R oen tg en Ra y S oc ie ty

R ad io log ic -P a tho log ic C on fe rences o f th e U niv e rs ity o f P ennsy lvan ia H osp ita l

G lycogen ic A can tho s isD av id Rose1 2 Emm a E . Fu rth1 , S tephen E . R ubes in3

G ly cogen ic acan thos is is a ben ign th icken ing of esoph-agea l squam ous ep ithe lium o f unknow n e tio logy tha t re su ltsin nodu la r and p laque -like e le va tions o f the m ucosa l su rfa ce .B ecause the nodu le s o f g lycogen ic acan thos is appea r in thefifth to s ix th decades o f life and becom e m ore num e rous andla rge r w ith in c reas ing age , the cond itio n is though t to be anage -re la ted , degene ra tive p rocess [1 ]. D esp ite the nam e ,the re is no assoc ia tion o f g lycogen ic acan thos is w ith abno r-m a litie s o f g lu cose m e tabo lism , such as d iabe tes , o r w iths k in d iso rde rs , such as pson ia s is o r acan thos is n ign icans .

G ly cogen ic acan thos is is seen in up to 30% of pa tien tsunde rgo ing doub le -con tra s t rad iog raphy [2 ]. The m ucosa l nod -u le s o r p laques range from 2 to 1 5 mm in d iam e ter and a relo ca ted p rim a rily in the m id -esophagus [2 , 3 ]. S om e nodu le sand p laques have sha rp edges tha t a re e tched in wh ite by ba r-ium ; o the r e le va tions have ill-de fined bonde rs tha tfade in to thepe riphe ry (F ig . 1A ). T he rad iog raph ic find ings can be con -fu sed w ith the fine ly nodu la r m ucosa seen in re flu x esophag i-tis and the p laques seen in Cand id a e so ph ag itis . G lyc og en icacan thos is , howeve r, u sua lly can be d is tingu ished from re flu xesophag itis and Cand id a esophag itis b y severa l cha rac ten is -tics . U n le ss there is a coex is ting d isease , pa tien ts w ith g lyco -gen ic acan thos is a re asym ptom a tic . P a tien ts w ith re flu x

esophag itis u sua lly a re sym p tom a tic , and the m ucosa l nodu larna tu re o r fin e g ranu la rity o f re flu x esophag itis is seen in thed is ta l e so ph ag us . Cand ida esophag itis u sua lly is de te c ted insym p tom a tic pa tien ts w ho a re im m unocom p rom ised . Thep laques o f Cand ida esophag itis a re a ligned in long itud ina llyo rien ted row s sepa ra ted by no rm a l m ucosa . T he p laques o fg lycogen ic acan thos is a re m ore random ly d is trib u ted .

P a tho log ica lly , the wh ite m ucosa l nodu le s o r p laques of g ly -cogen ic acan thos is a re lo ca ted p rim arily in the m id -esophagus(F ig . 1 B ). The squam ous ep ithe lium is fo ca lly th ickened byg roups o f en la rged , c lean ce lls lo ca ted in the uppe r la ye rs o f theep ithe lium (F ig . 1 C ) [4 ]. T he ce lls con ta in abundan t c y top la sm icg lycogen . The ce lls appea r c lea r because rou tine h is to log ic p ro -cess ing rem oves m os t cy top la sm ic g lycogen (F ig . 1 D ).

REFERENCES1 . G hahrem an i O C , R usho v ic h AM . G ly co ge n ic acan tho s is o f th e e sop ha gu s:

rad iog ra ph ic an d p atho log ic fea tu res . Ga s tr o in t es t R a d io I l9 8 4 ;9 : 93 - 982 . G lick SN , To p lick 5K , G o lds te in J , e t a l. G lyco ge n ic a ca n th os is o f th e

esophagus . AJ R 1982 ;139 :683 -6883 . Be rline r L , R e dm ond P , H orow itz L , R ou ff M . G ly co gen p laq ue s (g lyc o -

ge nic a ca nth os is ) o f the e so pha gu s. Rad io logy 1981 :141 :607 -6104 . R yw lin AM , O rte ga A . G lycog en ic a can th os is o f the eso ph ag us . Arch

Pa th o l 1970;90 : 439 -443

F ig . 1 .-G iycog en ic a can tho s is .A , Rad io g ra ph o f e sop ha gu s ob ta in ed a t a u top sy sh ow s n um ero us w ell-c irc um sc rib ed rad io lu ce nt p la qu es ( la rg e a rr ow s ) a nd n od ule s (smal l a r row )in the sh a llow ba rium coa tin g .B , P ho tog raph o f spec im en a t s am e m agn ific a tion show s num e ro us s lig h t ly ra ised wh ite p la qu es ( la rg e a rr ow s ) a nd n od ule s ( sm a ll a rr ow ).

C, L ow -p ow er p ho to micro grap h o f la rg est p laq ue id en tifie d b y a rro w in A sh ow s th at a re a o f g ly co ge nic a can th os is ( a r r ow) h as e xp en de d e pith elia lth ic kness by fac to r o f 4 .D, M ed ium -p ow e r p ho tom ic rog raph o f edg e o f p la qu e show s en la rg ed squ am ous ce lls w ith ab undan t c lear cy to p la sm in upp er lay ers o f ep ithe llu rn(r ep re se nta tiv e c le ar c ells ) ( a r row ) . A ltho ug h p er io dic ac id -S ch iff s ta in co lo rs g ly co gen p urp le , m os t g lyco gen h as been re mo ve d b y ro utin e h is to lo gic

p rocess ing , a nd cy top lasm o f m os t e n la rg ed ce lls is c le ar . S om e ce lls sh ow cy to plasm ic s ta in in g o f g ly co gen (as te r isk ) .