Department of Pathology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Mod Pathol. 2018 Nov;31(11):1653-1660. doi: 10.1038/s41379-018-0060-4. Epub 2018 Jun 19.
The diagnosis of Candida esophagitis can be challenging when the epithelium containing Candida filamentous forms is not readily seen or is entirely sloughed away. Mucosal inflammation could be helpful diagnostically, if distinctive. However it is thought to be nonspecific in Candida esophagitis. The goal of this retrospective study was to identify features of mucosal inflammation helpful in alerting a pathologist to the possibility of Candida esophagitis when Candida mycelia are not readily observed. The study group consisted of 99 consecutive cases of Candida esophagitis and a control group of 64 consecutive cases of reflux esophagitis diagnosed at our institution from 2008-2016. Band-like superficial intraepithelial neutrophils and increased intraepithelial lymphocytes were observed in 75 and 67% of Candida esophagitis cases, respectively and only in 14 and 19% of reflux esophagitis cases, respectively (p < .0001). Intraepithelial lymphocytes were peripapillary or CD4-predominant in 75% of Candida esophagitis cases with increased lymphocytes, in contrast to 17% of reflux esophagitis cases (p = .0011). Concurrent presence of intraepithelial neutrophils and increased lymphocytes showed increased specificity for Candida esophagitis and was observed in 61% of patients with Candida esophagitis and only in 2% of patients with reflux esophagitis (p < .0001). In addition, superficial band-like neutrophils were observed concurrently with increased peripapillary lymphocytes or CD4-predominant lymphocytes in 35 and 50% of Candida esophagitis cases, respectively, in contrast to no reflux esophagitis cases. Basal cell hyperplasia and elongation of stromal papillae were frequent in both groups. The data suggest that when Candida microorganisms are not readily observed, concurrent presence of superficial band-like neutrophils and increased lymphocytes may be indicative of Candida etiology of active esophagitis.
当含有假丝酵母菌丝状形态的上皮细胞不易被观察到或完全脱落时，假丝酵母菌食管炎的诊断可能具有挑战性。如果具有特征性，黏膜炎症可能具有诊断意义，但被认为在假丝酵母菌食管炎中是非特异性的。本回顾性研究的目的是确定有助于病理学家在不易观察到假丝酵母菌菌丝时警惕假丝酵母菌食管炎可能性的黏膜炎症特征。研究组包括 2008 年至 2016 年在我院诊断的 99 例连续假丝酵母菌食管炎病例和 64 例连续反流性食管炎病例。分别有 75%和 67%的假丝酵母菌食管炎病例观察到带状浅层上皮内中性粒细胞增多和上皮内淋巴细胞增多，而仅分别有 14%和 19%的反流性食管炎病例观察到这两种情况（p < .0001）。在有上皮内淋巴细胞增多的假丝酵母菌食管炎病例中，75%的上皮内淋巴细胞呈围管性或 CD4 优势，而在反流性食管炎病例中这一比例为 17%（p = .0011）。上皮内中性粒细胞增多和淋巴细胞增多同时存在时，对假丝酵母菌食管炎的特异性增加，在 61%的假丝酵母菌食管炎患者中观察到，而在 2%的反流性食管炎患者中观察到（p < .0001）。此外，在分别有 35%和 50%的假丝酵母菌食管炎病例中观察到浅带状中性粒细胞与增多的围管性淋巴细胞或 CD4 优势淋巴细胞同时存在，而反流性食管炎病例中均未观察到这种情况。两组均常见基底细胞增生和基质乳头伸长。数据表明，当不易观察到假丝酵母菌微生物时，同时存在浅带状中性粒细胞和淋巴细胞增多可能提示活动性食管炎的假丝酵母菌病因。
