Histopathologic findings of eosinophilic esophagitis in childhood

Year 2012, , 40 - 43, 01.08.2012

Arzu Ensari() Yasemin Yuyucu Karabulut()

https://doi.org/10.17940/endoskopi.74829

Abstract

Background and Aims:Eosinophilic esophagitis, a rare allergic disease of the esophagus, was recently recognized as a distinct entity in children. Esophage-al eosinophilia is the main histopathologic finding for its diagnosis, though it may be seen in various types of esophagitis. We, therefore, set out to evaluate the discriminatory value of currently available histologic criteria in the diag-nosis of eosinophilic esophagitis in children. Materials and methods: We ret-rospectively evaluated the esophageal biopsies of 145 children, admitted to Ankara University Medical School hospital, who suffered from gastrointestinal symptoms, between 2007 and 2011, and retrieved 7 cases of clinically confir-med eosinophilic esophagitis. The presence of papillary elongation, dilatation of intercellular spaces and basal cell hyperplasia was noted together with the number of intraepithelial eosinophils, neutrophils, and lymphocytes per high-power field. Presence of necrosis/erosions, subepithelial inflammation and fib-rosis, vascular congestion, and intestinal metaplasia was also recorded. Pati-ents' medical records to retrieve data regarding demographic information, cli-nical presentation, laboratory data, endoscopic findings and the response to treatment received before upper gastrointestinal endoscopy.Results: The age of the patients ranged from 6-17 years with a mean age of 10.57±3.42 years. There were 3 boys and 4 girls. Endoscopic abnormalities such as white exu-dates and furrowing were found in three patients while four had normal en-doscopy. Basal cell hyperplasia was found in three cases while papiller elon-gation was observed in 6 cases, three of which were mild and three were se-vere. Dilated intercellular spaces was observed in four cases, two of which we-re mild and two were severe. Eosinophilic microabscesses were observed in all cases. Median eosinophil count was 25 (min:12; max:78), while median lymphocyte count was 9 (min:2; max:33) within the squamous epithelium. No intraepithelial neutrophils were present. Conclusion: Histopathologic pa-rameters such as epithelial eosinophilia (>15/hpf), eosinophilic microabsces-ses and superficial crowding of eosinophils seem to be the main diagnostic cri-teria for eosinophilic esophagitis in childhood in the correct clinical context. Basal cell hyperplasia, papillary elongation and dilatation of intercellular spa-ces seem to be less discriminatory for the diagnosis of eosinophilic esophagi-tis as they represent reactive changes to injury.

Keywords

Eosinophilic esophagitis, histopathologic criteria, eosinophil co-unts

Çocukluk çağı eozinofilik özofajitlerinde histopatolojik bulgular

Abstract

Giriş ve Amaç:Eozinofilik özofajit çocuklarda yeni tanımlanmış, özofagusun allerjik hastalığıdır. Diğer özofajit tiplerinde de izlenmekle birlikte özofageal eozinofili, eozinofilik özofajit tanısında temel histopatolojik bulgudur. Çalış-mamızda çocuk yaş gurubunda eozinofilik özofajit tanısında histopatolojik kriterlerin tanımlayıcılığı değerlendirilmiştir. Gereç ve Yöntem: Çalışmamız-da 2007-2011 yılları arasında Ankara Üniversitesi Tıp Fakültesi hastanesine gastrointestinal sistem şikayetleri ile başvuran 145 çocuk olgunun özofageal biyopsi materyalleri retrospektif olarak değerlendirilmiş ve klinik konfirmas-yonu da sağlanan 7 eozinofilik özofajit olgusu çalışmaya dahil edilmiştir. His-topatolojik olarak papiller elongasyon, bazal hücre hiperplazisi ve dilate in-tersellüler boşluklar, büyük büyütme alanında saptanan intraepitelyal eozino-fil, nötrofil ve lenfosit sayıları ile birlikte değerlendirilmiştir. Nekroz/erozyon varlığı, subepitelyal fibrozis ve inşamasyon bulguları da ayrıca değerlendiril-miştir. Hastaların demografik verileri, başvuru şikayetleri, endoskopi öncesi tedavi alıp almadıkları ve endoskopik bulguları hasta kayıtlarından edinilmiş-tir. Bulgular: Hastaların yaş ortalaması 10.57±3.42 (6-17 yaş) olarak saptan-mıştır. Hastaların 3'ü erkek, 4'ü kız olup, olguların sadece 3'ünde özofagusta oluk şeklinde çizgilenme ve beyaz exudasyon olmak üzere anormal endosko-pik bulgular saptanmıştır. Üç olguda bazal hücre hiperplazisi saptanırken, 3 olguda hafif, 3 olguda ise şiddetli olmak üzere toplam 6 olguda papiller elon-gasyon izlenmiştir. Ayrıca ikisi hafif ve ikisi şiddetli olmak üzere toplam 4 ol-guda dilate intersellüler boşluklar saptanmıştır. Olguların tümünde eozinofi-lik mikroabseler görülmüş ve ortanca eozinofil değeri 25 (min:12; max:78), ortanca lenfosit değeri ise 9 (min:2; max:33) olarak bulunmuştur. ‹ntraepitel-yal nötrofil görülmemiştir. Sonuç: Çocukluk çağında eozinofilik özofajit ta-nısına epitelyal eozinofili (>15 /hpf), eozinofilik mikroabseler ve yüzeyel eo-zinofilik dansite artışı gibi major histopatolojik parametrelerin klinik bulgu-larla birlikte değerlendirilmesiyle ulaşılabilir, papiller elongasyon, bazal hüc-re hiperplazisi ve dilate intersellüler boşluklar gibi minör histopathologic pa-rametrelerin yol göstericiliği sınırlıdır

Keywords

Eozinofilik özofajit, histopatolojik kriterler, eozinofil sayısı

References

• Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: up- dated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128: 3-20.
• Moawad FJ, Veerappan GR, Wong RK. Eosinophilic esophagitis. Dig Dis Sci 2009; 54: 1818-28.
• Yan BM, Shaffer EA. Primary eosinophilic disorders of the gastrointesti- nal tract. Gut 2009; 58: 721-32.
• Odze RD. Pathology of eosinophilic esophagitis: what the clinician needs to know. Am J Gastroenterol 2009; 104: 485-90.
• Mueller S, Aigner T, Neureiter D, Stolte M. Eosinophile infiltration and degranulation in oesophageal mucosa from adult patients with eosinop- hilic oesophagitis: a retrospective and comparative study on pathologi- cal biopsy. J Clin Pathol 2006; 59: 1175-80.
• Rothenberg ME. Biology and treatment of eosinophilic esophagitis. Gat- roenterology 2009; 137: 1238-49.
• Schoepfer AM, Simon D, Straumann A. Eosinophilic oesophagitis: latest intelligence. Clin Exp Allergy 2011; 41: 630-9.
• Potter JW, Saeian K, Staff D, et al. Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest Endosc 2004; 59: 355-61.
• Liacouras CA, Spergel JM, Ruchelli E, et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol 2005; 3: 1198-206.
• Chehade M, Sampson HA, Morotti RA, Magid MS. Esophageal subepit- helial fibrosis in children with eosinophilic esophagitis. J Pediatr Gastro- enterol Nutr 2007; 45: 319-28.
• Gonsalves N, Policarpio-Nicolas M, Zhang Q, et al. Histopathologic va- riability and endoscopic correlates in adults with eosinophilic esophagi- tis. Gastrointest Endosc 2006; 64: 313-9.