Original ArticlesLymphocyte-predominant Esophagitis A Distinct and Likely Immune-mediated Disorder Encompassing Lymphocytic and Lichenoid EsophagitisPittman, Meredith E. MD*; Hissong, Erika MD*; Katz, Philip O. MD†; Yantiss, Rhonda K. MD*Author Information Departments of *Pathology and Laboratory Medicine †Medicine, Division of Gastroenterology, Weill Cornell Medicine, New York, NY Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Rhonda K. Yantiss, MD, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, 525 East 68th Street, Starr 1031D, New York, NY 10065 (e-mail: [email protected]). The American Journal of Surgical Pathology: February 2020 - Volume 44 - Issue 2 - p 198-205 doi: 10.1097/PAS.0000000000001394 Buy Metrics Abstract Lymphocytic esophagitis is a well-known manifestation of Crohn disease among children but is not considered to be an immune-mediated mucositis in adults. We hypothesize that adult-onset lymphocyte-predominant esophagitis is also an immune-mediated inflammatory pattern, the nature of which has been masked by other conditions that feature esophageal lymphocytosis and occur in older patients. We performed this study to consolidate diagnostic criteria for lymphocyte-predominant esophagitis and determine its clinical significance. We identified 61 patients with lymphocyte-rich inflammation in the mid or proximal esophagus, none of whom had another explanation for esophageal lymphocytosis. Affected patients were usually older adults and 72% were women. Most (56%) presented with dysphagia and 34% had eosinophilic esophagitis-like changes with rings, exudates, and/or edematous mucosa and linear furrows. Intraepithelial lymphocytosis was accompanied by mucosal injury featuring edema, basal zone hyperplasia, and scattered dyskeratotic cells. Some cases displayed occasional neutrophils or even superficial microabscesses; eosinophils were consistently infrequent. Most (67%) patients had at least 1 systemic immune-mediated disorder, particularly Crohn disease (30%) and connective tissue diseases (23%); only 1 had mucocutaneous lichen planus. We conclude that mild mucosal lymphocytosis (ie, ≥20 lymphocytes/HPF) alone is a frequent and nonspecific finding; criteria for lymphocyte-predominant esophagitis should include evidence of mucosal injury and allow for more than the occasional neutrophil. When this diagnosis is limited to cases that feature lymphocytosis unattributed to acid reflux, motility disorders, or infection, lymphocyte-predominant esophagitis may represent an immune-mediated disorder with characteristic clinical manifestations and a predilection for middle-aged women. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.