Subtitle: Oesophageal candidiasis on biopsy: when to suspect it (parakeratosis, acute inflammation), diagnostic criteria (invasive pseudohyphae), when to use PAS and GMS, HSV and CMV mimics, three virtual slides, a case question and 8 MCQs.
Author: PathologyMCQ Editorial Board
Category: Gastrointestinal Pathology
Last Updated: October 2026
Read Time: 5 minutes
At-a-Glance
- Suspect it when you see prominent parakeratosis and striking acute inflammation.
- Diagnose it only when pseudohyphae invade the squamous epithelium.
- Yeasts alone may be oral contamination.
- PAS / GMS when clues are present but organisms are not seen on H&E.
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When to Suspect Oesophageal Candidiasis
- Prominent parakeratosis: Candida colonises the parakeratotic surface layer.
- Striking acute inflammation: neutrophils in the superficial epithelium.
Essentials for Diagnosis
- Pseudohyphae signify tissue invasion and are required for the diagnosis.
- Budding yeasts alone can represent oral contamination and are not sufficient.
Are Special Stains Essential in All Cases?
No. PAS, PAS-diastase or GMS highlight fungal forms and are advised when organisms are not seen on H&E but there is a clinical impression of candidiasis, striking acute inflammation or prominent parakeratosis.
Virtual Slides
Compare Candida oesophagitis with the two viral infections it can coexist with or mimic.
What to look for
Drag to pan · pinch or double-tap to zoom · use the + / − buttons
Infectious Oesophagitis
| Organism | Where to look | Key features |
|---|---|---|
| Candida | Surface, parakeratotic layer | Pseudohyphae and yeasts; neutrophils; PAS/GMS |
| Herpes simplex | Squamous cells at ulcer edge | Multinucleation, moulding, margination; HSV IHC |
| CMV | Endothelial and stromal cells in ulcer base | Owl-eye nuclear and cytoplasmic inclusions; CMV IHC |
Read more: Non-neoplastic oesophageal biopsies → · Eosinophilic oesophagitis →
Case Question
Which of the following is false regarding this oesophageal biopsy in a 35-year-old man with dysphagia?
A. Presence of pseudohyphae is diagnostic · B. Special stains are required in all cases · C. Budding yeast alone is not sufficient for the diagnosis · D. Prominent parakeratosis is a clue
Show answer
B is false. Special stains are not essential in all cases; use them when pseudohyphae are not evident on H&E but there is a clinical impression of candidiasis, striking acute inflammation or prominent parakeratosis.
Test Yourself: 8 MCQs
Oesophageal candidiasis: 8 MCQs
Diagnostic criteria, stains and infectious mimics, with instant explanations.
More practice: the question banks →
Exam Pearls
- Pseudohyphae in epithelium = diagnosis; yeasts alone = possible contamination.
- Parakeratosis + neutrophils: look hard, then stain.
- HSV: squamous cells at ulcer edge. CMV: stromal and endothelial cells in ulcer base.
For more diagnostic tips, join the approach-based course in histopathology and cytology →
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Related reads: Chronic active gastritis → · Eosinophilic oesophagitis →
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References
- Fenoglio-Preiser CM, Lantz ME. Non-Neoplastic Pathology of the Gastrointestinal Tract: A Practical Guide to Biopsy Diagnosis. Cambridge University Press; 2020.
- Mohamed AA, Lu XL, Mounmin FA. Diagnosis and treatment of esophageal candidiasis: current updates. Can J Gastroenterol Hepatol. 2019;2019:3585136.
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