Haque S, Genta RM.
Caris Diagnostics, Irving, TX, USA.
Editor’s note: The authors, who work at a large private clinical pathology center servicing mainly outpatient ambulatory cases in the US, identified a relatively large number of cases who had dense lymphocytic infiltrates in esophageal biopsies. Reviewing >100 000 patients who had had esophageal biopsies taken, there were 119 cases of lymphocytic esophagitis (defined as ≥30 lymphocytes per high power field), occurring mainly in middle-aged women. The diagnosis of lymphocytic esophagitis represented approximately 1 per 1000 cases of patients who had esophageal biopsies taken. Approximately 50% of the patients with lymphocytic esophagitis had dysphagia – this is similar to the proportion that is found in patients with eosinophilic esophagitis. Presentation with typical gastroesophageal reflux symptoms was rather rare – less common than it was in other cases of esophagitis or in those who had had normal esophageal biopsies taken. In approximately one-third of cases, the endoscopist’s impression was that of eosinophilic esophagitis based on felinization with furrows, white plaques, and strictures. Histochemical staining demonstrated that virtually all of the lymphocytes were CD3+ T cells, with the majority of these being CD8+. The etiology and clinical significance of the findings of dense lymphocytic infiltrates remains to be determined, but the possibility that lymphocytic esophagitis underlies some cases that clinically were thought to be eosinophilic esophagitis should prompt more evaluation of this condition in other populations.