Abstract
Objectives: We undertook the first case control study of histologically confirmed esophageal candidiasis (EC). Methods: A computer search from July 2012 through February 2015 identified 1, 011 esophageal specimens, including 40 cases of EC and 20 controls. Results: The EC incidence was 5.2%; it was associated with immunosuppression and endoscopic white plaques and breaks. Smoking was a predisposing factor, and alcohol was protective. EC had no unique symptoms, and 54% of endoscopic reports did not suspect EC. Important histologic clues included superficial and detached fragments of desquamated and hyper-pink parakeratosis, acute inflammation, intraepithelial lymphocytosis, dead keratinocytes, and bacterial overgrowth. Thirty percent had no neutrophilic infiltrate. Pseudohyphae were seen on H&E in 92.5% (n=37/ 40). "Upfront" periodic acid-Schiff with diastase (PAS/D) on all esophageal specimens would have generated $68, 333.49 in patient charges. Our targeted PAS/D strategy resulted in $13, 044.87 in patient charges (cost saving=80.9%, $55, 288.62). Conclusions: We describe the typical morphology of EC and recommend limiting PAS/D to cases where the organisms are not readily identifiable on H&E and with at least one of the following: (1) ulcer, (2) suspicious morphology, and/or (3) clinical impression of EC.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 33-42 |
| Number of pages | 10 |
| Journal | American Journal of Clinical Pathology |
| Volume | 147 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2017 |
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Keywords
- Desquamated
- Esophageal candidiasis (EC)
- Hyper-pink
- Parakeratosis
- Periodic acid-Schiff with diastase (PAS/D)
- Pseudohyphae
ASJC Scopus subject areas
- Pathology and Forensic Medicine
Cite this
Challenges to "classic" esophageal candidiasis : Looks are usually deceiving. / Alsomali, Mohammed I.; Arnold, Michael A.; Frankel, Wendy L.; Graham, Rondell; Hart, Phil A.; Lam-Himlin, Dora M.; Naini, Bita V.; Voltaggio, Lysandra; Arnold, Christina A.
In: American Journal of Clinical Pathology, Vol. 147, No. 1, 2017, p. 33-42.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Challenges to "classic" esophageal candidiasis
T2 - Looks are usually deceiving
AU - Alsomali, Mohammed I.
AU - Arnold, Michael A.
AU - Frankel, Wendy L.
AU - Graham, Rondell
AU - Hart, Phil A.
AU - Lam-Himlin, Dora M.
AU - Naini, Bita V.
AU - Voltaggio, Lysandra
AU - Arnold, Christina A.
PY - 2017
Y1 - 2017
N2 - Objectives: We undertook the first case control study of histologically confirmed esophageal candidiasis (EC). Methods: A computer search from July 2012 through February 2015 identified 1, 011 esophageal specimens, including 40 cases of EC and 20 controls. Results: The EC incidence was 5.2%; it was associated with immunosuppression and endoscopic white plaques and breaks. Smoking was a predisposing factor, and alcohol was protective. EC had no unique symptoms, and 54% of endoscopic reports did not suspect EC. Important histologic clues included superficial and detached fragments of desquamated and hyper-pink parakeratosis, acute inflammation, intraepithelial lymphocytosis, dead keratinocytes, and bacterial overgrowth. Thirty percent had no neutrophilic infiltrate. Pseudohyphae were seen on H&E in 92.5% (n=37/ 40). "Upfront" periodic acid-Schiff with diastase (PAS/D) on all esophageal specimens would have generated $68, 333.49 in patient charges. Our targeted PAS/D strategy resulted in $13, 044.87 in patient charges (cost saving=80.9%, $55, 288.62). Conclusions: We describe the typical morphology of EC and recommend limiting PAS/D to cases where the organisms are not readily identifiable on H&E and with at least one of the following: (1) ulcer, (2) suspicious morphology, and/or (3) clinical impression of EC.
AB - Objectives: We undertook the first case control study of histologically confirmed esophageal candidiasis (EC). Methods: A computer search from July 2012 through February 2015 identified 1, 011 esophageal specimens, including 40 cases of EC and 20 controls. Results: The EC incidence was 5.2%; it was associated with immunosuppression and endoscopic white plaques and breaks. Smoking was a predisposing factor, and alcohol was protective. EC had no unique symptoms, and 54% of endoscopic reports did not suspect EC. Important histologic clues included superficial and detached fragments of desquamated and hyper-pink parakeratosis, acute inflammation, intraepithelial lymphocytosis, dead keratinocytes, and bacterial overgrowth. Thirty percent had no neutrophilic infiltrate. Pseudohyphae were seen on H&E in 92.5% (n=37/ 40). "Upfront" periodic acid-Schiff with diastase (PAS/D) on all esophageal specimens would have generated $68, 333.49 in patient charges. Our targeted PAS/D strategy resulted in $13, 044.87 in patient charges (cost saving=80.9%, $55, 288.62). Conclusions: We describe the typical morphology of EC and recommend limiting PAS/D to cases where the organisms are not readily identifiable on H&E and with at least one of the following: (1) ulcer, (2) suspicious morphology, and/or (3) clinical impression of EC.
KW - Desquamated
KW - Esophageal candidiasis (EC)
KW - Hyper-pink
KW - Parakeratosis
KW - Periodic acid-Schiff with diastase (PAS/D)
KW - Pseudohyphae
UR - http://www.scopus.com/inward/record.url?scp=85017510548&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85017510548&partnerID=8YFLogxK
U2 - 10.1093/AJCP/AQW210
DO - 10.1093/AJCP/AQW210
M3 - Article
C2 - 28158394
AN - SCOPUS:85017510548
VL - 147
SP - 33
EP - 42
JO - American Journal of Clinical Pathology
JF - American Journal of Clinical Pathology
SN - 0002-9173
IS - 1
ER -