White Nummular Lesions in Esophageal Mucosa
White Nummular Lesions in Esophageal Mucosa White nummular lesions in the esophageal mucosa are a relatively uncommon but noteworthy endoscopic finding that can indicate a variety of underlying conditions. These lesions typically appear as well-defined, white, coin-shaped patches on the esophageal lining, and their presence warrants careful evaluation to determine the cause and appropriate management.
White Nummular Lesions in Esophageal Mucosa The differential diagnosis for white nummular esophageal lesions is broad. One of the most frequent causes is Candida esophagitis, a fungal infection resulting from Candida species. It commonly occurs in immunocompromised individuals, such as those with HIV/AIDS, cancer patients on chemotherapy, or individuals on long-term corticosteroid therapy. Clinically, patients may report symptoms like dysphagia, odynophagia, or may be asymptomatic, with the lesions discovered incidentally during endoscopy.
White Nummular Lesions in Esophageal Mucosa Apart from fungal infections, other infectious causes include viral esophagitis caused by herpes simplex virus or cytomegalovirus, which can also present with white plaques or patches that may resemble nummular lesions. These are often accompanied by other features such as ulcerations or erythema, and histopathological examination can aid in differentiation.
White Nummular Lesions in Esophageal Mucosa In addition to infectious causes, non-infectious etiologies should be considered. Eosinophilic esophagitis, a chronic immune-mediated condition, occasionally presents with white exudates or plaques composed of eosinophil-rich debris on the esophageal mucosa. These lesions are often associated with other features such as concentric rings or furrows seen on endoscopy.
White Nummular Lesions in Esophageal Mucosa Another consideration is esophageal leukoplakia, a rare, benign white lesion that appears as a plaque or patch. While generally asymptomatic, it warrants biopsy to exclude dysplasia or malignant transformation. Similarly, hyperpla
stic or regenerative changes in the mucosa due to injury or inflammation may also manifest as white patches.
Diagnosis of these lesions hinges on endoscopic visualization, histopathology, and microbiological studies. Biopsy is often necessary to distinguish between infectious, inflammatory, or neoplastic processes. For fungal infections, special stains such as Periodic acid–Schiff (PAS) or Gomori methenamine silver (GMS) can confirm Candida. Viral infections may be identified via immunohistochemistry or PCR testing.
White Nummular Lesions in Esophageal Mucosa Management strategies depend on the identified cause. Fungal esophagitis responds well to antifungal agents like fluconazole or itraconazole. Viral infections may require antiviral therapy, while eosinophilic esophagitis is managed with dietary modifications, corticosteroids, or other anti-inflammatory agents. Precancerous lesions like leukoplakia necessitate close follow-up and possible resection if dysplasia is detected.
In summary, white nummular lesions in the esophageal mucosa are a diagnostic challenge but also an opportunity to identify underlying conditions that can range from infectious to inflammatory or neoplastic. Accurate diagnosis through endoscopic and histological assessment is crucial for targeted treatment and improved patient outcomes.
