When to suspect Esophageal candidiasis in an Esophageal biopsy?

1. Presence of prominent parakeratosis
2. Striking acute inflammation

Essentials for diagnosis

1. Pseudohyphal forms signify tissue invasion and are required for diagnosis
2. Presence of budding yeast alone can also represent oral contamination and hence are not sufficient for the diagnosis of Esophageal candidiasis

Are special stains essential in all cases?

PAS (Periodic acid schiff), PAS/AB (Alcian blue), and GMS (Gomori methanaine silver) special stains highlight fungal forms and are advised in the following cases, assuming the fungal forms are not present on H&E (Hematoxylin and eosin):

• Clinical impression of candidiasis
• Striking acute inflammation
• Prominent parakeratosis

Try to answer this case diagnosis based MCQ

Which of the following is false regarding this Esophageal biopsy in a 35 year old male with dysphagia?

Correct answer is B: Special stains are not essential in all cases.

Special stains may be performed in the following cases when pseudohyphae is not evident on H and E.

• Clinical impression of candidiasis
• Striking acute inflammation
• Prominent parakeratosis

References

1. Fenoglio-Preiser, Cecilia M., and Mary E. Lantz. Non-Neoplastic Pathology of the Gastrointestinal Tract: A Practical Guide to Biopsy Diagnosis with Online Resource. Cambridge University Press, 2020.
2. Mohamed AA, Lu XL, Mounmin FA. Diagnosis and Treatment of Esophageal Candidiasis: Current Updates. Can J Gastroenterol Hepatol. 2019 Oct 20;2019:3585136

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