Glycogenic acanthosis

Glycogenic acanthosis is a benign finding on esophagography in elderly patients.

Epidemiology

It most commonly occurs in patients >40 years of age and incidence and numbers of lesions increase by age. No gender predilection exists. Typically patients are asymptomatic. 

Pathology

It occurs from a combination of cellular hyperplasia and increased cellular glycogen in squamous epithelial cells lining the esophagus. The esophageal mucosa is otherwise normal. It is not thought to be associated with gastro-esophageal reflux.

Severe forms are seen in patients with Cowden syndrome.

Radiographic features

• multiple small nodules and plaques measuring 2-10 mm
• plaques are randomly distributed
• often in the upper to mid thoracic esophagus
• the appearance can appear similar to other forms of esophagitis like reflux esophagitis which however occur more distally and candida esophagitis which is more linear in configuration 

Differential diagnosis

• granular mucosal pattern of the esophagus (differential)
• squamous papillomatosis of the esophagus