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<p class="ql-align-justify">Superficial esophageal mucosal fragments with prominent intraepithelial eosinophilia, greatest in the superficial and mid-epithelial layers. Peak counts show multiple foci with ≥15 eosinophils per high-power field (HPF, 400×), with occasional eosinophil microabcsesses (clusters of ≥4 eosinophils). There is associated basal cell hyperplasia with expansion of the basal layer, focal elongation of papillae into the upper third of the epithelium, and spongiosis (intercellular edema). Surface epithelial sloughing and scattered degranulated eosinophils are noted. No evidence of atypia or malignancy.</p>
<p class="ql-align-justify">Dysphagia. Multiple biopsies from the esophagus to exclude esinophilic esophagitis.</p>
<p class="ql-align-justify">Soft tissue fragments collectively measured 0.7 cm, totally embedded.</p>
<h3><strong><em><u>Esophageal endoscopic biopsy:</u></em></strong></h3><ul><li><strong>Consistent with eosinophilic esophagitis. </strong></li><li><strong>Negative for malignancy. </strong></li></ul><p><br></p><h5><strong>COMMENT</strong>:</h5><h5 class="ql-align-justify">The histologic findings are most compatible with eosinophilic esophagitis (EoE), an immune-mediated esophageal disorder characterized by dense intraepithelial eosinophilia and epithelial remodeling. Correlation with the clinical history (dysphagia, food bolus impaction, heartburn, atopic history including asthma/allergic rhinitis/eczema) and endoscopic findings (ringing, linear furrows, white exudates, strictures) is advised. A peak eosinophil count >15 eosinophils/HPF supports the diagnosis, but similar eosinophil infiltrates can be seen with gastroesophageal reflux disease (GERD), proton pump inhibitor–responsive esophageal eosinophilia (PPI-REE), pill esophagitis, and parasitic or systemic eosinophilic disorders; clinical correlation and documentation of treatment/response to PPI therapy are recommended.</h5>
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