96

Radiologic-Pathologic

Conferences

of the University of Pennsylvania

Hospital

Glycogenic
David Rose12 Emma

Acanthosis
E. Furth1
,

Stephen

E. Rubesin3

Glycogenic acanthosis is a benign thickening of esophageal squamous epithelium of unknown etiology that results in nodular and plaque-like elevations of the mucosal surface. Because the nodules of glycogenic acanthosis appear in the fifth to sixth decades of life and become more numerous and larger with increasing age, the condition is thought to be an age-related, degenerative process [1]. Despite the name, there is no association of glycogenic acanthosis with abnormalities of glucose metabolism, such as diabetes, or with skin disorders, such as psoniasis or acanthosis nignicans. Glycogenic acanthosis is seen in up to 30% of patients undergoing double-contrast radiography [2]. The mucosal nodules or plaques range from 2 to 15 mm in diameter and are located primarily in the mid-esophagus [2, 3]. Some nodules and plaques have sharp edges that are etched in white by barium; other elevations have ill-defined bonders thatfade into the periphery (Fig. 1A). The radiographic findings can be confused with the finely nodular mucosa seen in reflux esophagitis and the plaques seen in Candida esophagitis. Glycogenic acanthosis, however, usually can be distinguished from reflux esophagitis and Candida esophagitis by several charactenistics. Unless there is a coexisting disease, patients with glycogenic acanthosis are asymptomatic. Patients with reflux

esophagitis usually are symptomatic, and the mucosal nodular nature or fine granularity of reflux esophagitis is seen in the distal esophagus. Candida esophagitis usually is detected in symptomatic patients who are immunocompromised. The plaques of Candida esophagitis are aligned in longitudinally oriented rows separated by normal mucosa. The plaques of glycogenic acanthosis are more randomly distributed. Pathologically, the white mucosal nodules or plaques of glycogenic acanthosis are located primarily in the mid-esophagus (Fig. 1 B). The squamous epithelium is focally thickened by groups of enlarged, clean cells located in the upper layers of the epithelium (Fig. 1 C) [4]. The cells contain abundant cytoplasmic glycogen. The cells appear clear because routine histologic processing removes most cytoplasmic glycogen (Fig. 1 D). REFERENCES
1 . Ghahremani OC, Rushovich AM. Glycogenic acanthosis of the esophagus: radiographic and pathologic features. Gastrointest RadioIl984;9:93-98 2. Glick SN, Toplick 5K, Goldstein J, et al. Glycogenic acanthosis of the esophagus. AJR 1982;139:683-688 3. Berliner L, Redmond P, Horowitz L, Rouff M. Glycogen plaques (glycogenic acanthosis) of the esophagus. Radiology 1981:141:607-610 4. Rywlin AM, Ortega A. Glycogenic acanthosis of the esophagus. Arch Pathol 1970;90:439-443

Fig. 1.-Giycogenic acanthosis. A, Radiograph of esophagus obtained at autopsy shows numerous well-circumscribed radiolucent plaques (large arrows) and nodules (small arrow) in the shallow barium coating. B, Photograph of specimen at same magnification shows numerous slightly raised white plaques (large arrows) and nodules (small arrow). C, Low-power photomicrograph of largest plaque identified by arrow in A shows that area of glycogenic acanthosis (arrow) has expended epithelial

thickness

by factor of 4.
photomicrograph of most of edge of plaque shows enlarged squamous cells with abundant clear cytoplasm in upper layers of epithellurn

D, Medium-power

(representative
processing,

clear cells) (arrow).

Although
enlarged

and cytoplasm

periodic acid-Schiff stain colors glycogen purple, most glycogen has been removed by routine histologic cells is clear. Some cells show cytoplasmic staining of glycogen (asterisk).
of Pennsylvania,

Department

of Pathology,

Hospital

of the University

3400 Spruce

St., Philadelphia,

PA 19104. PA 19104. Address correspondence to 5. E.

2Present address: Department of Radiology, Brigham and Womens Hospital, 75 Francis 3Department of Radiology, MRI Bldg. 1, Hospital of the University of Pennsylvania, 3400 Rubesin. AJR 1995;164:96 0361-803X/95/1641-96 American Roentgen Ray Society

St., Boston, MA 02115. Spruce St., Philadelphia,