Ectopic Sebaceous Glands in the Esophagus: Endoscopic Findings over Three Years

Distribution of Vernix Caseosa and Associated Factors Among Newborns Delivered at Adama Comprehensive Specialized Hospital Medical College, Ethiopia, in 2022: Cross-Sectional Study

Background

Vernix caseosa is a complex proteolipid material synthesized partly by fetal sebaceous glands during the last trimester of pregnancy. Understanding the structure and function of newborn skin is crucial for determining optimal thermal support, infection control, and skin moisturization. So far, in Ethiopia, there is no research done related to the distribution of vernix caseosa and associated factors on newborn skin. Doing such research could give awareness about factors associated with the distribution of vernix caseosa on newborns' skin and to take necessary protective measures for those that may be affected.

Objective

The objective of this study is to assess the distribution of vernix caseosa and associated factors among newborns delivered at Adama Comprehensive Specialized Hospital Medical College from November to December 1, 2021.

Methodology

Hospital-based cross-sectional study design was conducted from November to December 1, 2021 at Adama Comprehensive Specialized Hospital Medical College (ACSHMC). Four hundred twenty-two eligible newborns were selected by a systematic sampling method. Data were collected by four data collectors by using a pretested questionnaire. The distribution of vernix caseosa on the different regions of the neonate was assessed, by exposing their whole body for a minute. Data entry was done by EPI data version 4.6 and analyzed by using SPSS version 25. A logistic regression of P-value of <0.25 during bivariate and P < 0.05 during multivariate analysis at a 95% confidence level was considered statistically significant.

Results

Out of 422 study participants 231 (54.7%) with 95% CI (49.8, 59.8) babies had vernix caseosa. Being primiparous with (AOR = 1.9, PV = 0.013, 95% CI: 1.141, 2.92), being multiparous with (AOR = 1.98, PV = 0.04, CI: 1.29, 3.225), being females with (AOR = 2.1, PV = 0.001, CI: 1.39, 3.18), being preterm with (AOR = 2.98, PV = 0.036, 95% CI: 1.08, 10.72), non-diseased newborns with (AOR = 1.6, PV = 0.046, 95% CI: 1.07, 2.7) were identified as associated factors for the distribution of vernix caseosa on the newborn skin.

Conclusion

This study showed that the distribution of vernix caseosa on the skin of the newborns was associated with parity, sex, gestational age, and absence of disease.

Magnifying Endoscopy for Esophageal Ectopic Sebaceous Glands

Ectopic sebaceous glands are found very rarely in the esophagus; heretofore, several cases have been reported. The sebaceous gland is originally a source of an endodermal origin; however, there have been controversies regarding whether the origin of the esophageal ectopic sebaceous gland is ectodermal or endodermal. Ectopic sebaceous glands of the esophagus usually do not cause symptoms; thus, they are often found incidentally on endoscopy for routine health screening. Endoscopic findings are characterized by single or multiple yellow patches or nodular lesions of various sizes, sometimes with small central openings. We report two cases of esophageal ectopic sebaceous glands found incidentally during endoscopy with magnifying endoscopic findings. The lesions were in the mid-esophagus and lower esophagus, respectively, and both endoscopic findings were similar as multiple yellowish patches or plaques. Magnifying endoscopy revealed the openings of the excretory ducts surrounded by circular microvessels in both cases.

Heterotopic sebaceous glands in the esophagus, a very rare histopathological diagnosis: a case report and review of the literature

Sebaceous glands are very rarely found in the esophagus. Existing reports do not contain sufficient epidemiological, etiological, clinical, or prognostic data. Its histogenesis suggests heterotopia or metaplasia. Despite its extreme rarity, correct and generally easy identification enables establishing the proper patient monitoring.

Prevalence rate and clinical characteristics of esophageal ectopic sebaceous glands in asymptomatic health screen examinees

Ectopic sebaceous glands in the esophagus have rarely been reported and, thus, represent an obscure medical condition. The aim of this study is to identify the prevalence rate and clinical characteristics of this lesion in an asymptomatic population. We prospectively enrolled health screen examinees who underwent esophagogastroduodenoscopy for gastric cancer screening. An esophageal biopsy was performed in the cases in which esophageal ectopic sebaceous glands were suspected. The general characteristics of the examinees were analyzed based on their medical records. A total of 9989 examinees were enrolled, and five examinees were diagnosed with esophageal ectopic sebaceous glands between December 2012 and June 2014. The endoscopic findings of the esophageal ectopic sebaceous glands indicated multiple yellowish patches or papules, which varied in size. The histopathological findings indicated several lobulated sebaceous glands in the squamous epithelium with inflammatory infiltration. The follow-up endoscopic findings indicated that there was no grossly discernible change. In conclusion, esophageal ectopic sebaceous glands are present in 0.05% of asymptomatic subjects. This lesion is thought to be benign and is not related to clinical symptoms. Therefore, esophageal ectopic sebaceous glands do not require further treatment or follow-up, which makes endoscopists free from active efforts for differential diagnosis with other malignant diseases.

[About 2 cases of ectopic sebaceous glands in esophagus: Endoscopic and histological correlations from biopsies and resected specimens]

Sebaceous glands are cutaneous annexes located in the dermis. Focal spots of ectopy of these glands are frequently identified in ectodermal tissues: they represent Fordyce's disease. However, only a few cases of ectopic sebaceous glands have been mentioned in non-ectodermic tissue. Fordyce spots of esophageal location are unusual, and most of them have been diagnosed from biopsy specimens. We report two cases of ectopic sebaceous glands in esophagus, the first diagnosed from a resected specimen, the second from biopsies. A literature review is carried out.

Diagnostic pitfall of sebaceous gland metaplasia of the esophagus

We investigated the sebaceous gland metaplasia (SGM) of the esophagus and clarified the evidence of misdiagnosis and its diagnosis pitfall. Cases of pathologically proven SGM were enrolled in the clinical analysis and reviewed description of endoscope. In the current study, we demonstrated that SGM is very rare esophageal condition with an incidence around 0.00465% and an occurrence rate of 0.41 per year. There were 57.1% of senior endoscopists identified 8 episodes of SGM. In contrast, 7.7% of junior endoscopists identified SGM in only 2 episodes. Moreover, we investigated the difference in endoscopic biopsy attempt rate between the senior and junior endoscopist (P = 0.0001). The senior endoscopists had more motivation to look for SGM than did junior endoscopists (P = 0.01). We concluded that SGM of the esophagus is rare condition that is easily and not recognized in endoscopy studies omitting pathological review.