Case Report of a Proposed, Novel, Endoscopic “Whitehead Pimple” Sign of Ectopic Esophageal Sebaceous Glands Based on Their Mimicking the Dermatologic and Histopathologic Characteristics of Cutaneous Whitehead Pimples/Closed Comedones

  • Amy Le
  • Mitual Amin
  • Mitchell S. CappellEmail author
Case Report

Endoscopic signs help characterize endoscopic lesions. The endoscopic appearance of esophageal ectopic sebaceous glands (ESGs/Fordyce lesions) has been described in several case reports [1, 2], but none have described its endoscopic appearance as potentially characteristic or mimicking a type of cutaneous sebaceous glands. This report describes that its endoscopic appearance and histopathology mimics that of cutaneous closed comedones (colloquially, whitehead pimples), explains the pathophysiology, and reports a novel potentially diagnostic endoscopic sign.

A 78-year-old-female presented with postprandial-abdominal-pain. Physical examination and routine laboratory tests were within-normal-limits. Esophagogastroduodenoscopy (EGD) revealed numerous, 3–4-mm-wide, discrete, pinkish, mucosal plaques with prominent, white, central punctae (Fig.  1a, b) in clusters in middle and distal esophagus with normal intervening mucosa (and unremarkable stomach and duodenum). Histopathologic analysis...


Ectopic sebaceous glands Fordyce spots Comedones Esophagus Esophagogastroduodenoscopy Endoscopic sign 


Compliance with ethical standards

Conflict of interest

None. In particular, Dr. Cappell, as a consultant of the United States Food and Drug Administration (FDA) Advisory Committee for Gastrointestinal Drugs, affirms that this paper does not discuss any proprietary confidential pharmaceutical data submitted to the FDA. Dr. Cappell was a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, co-marketers of Movantik and did receive one-time consulting fees from Mallinckrodt and Shire. This work does not discuss any drug manufactured or marketed by AstraZeneca, Daiichi Sankyo, Shire, or Mallinckrodt.

IRB approval

This study received approval from the IRB of William Beaumont Hospital at Royal Oak on June 27, 2018.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PathologyWilliam Beaumont Hospital at Royal OakRoyal OakUSA
  2. 2.Arizona College of Osteopathic MedicineGlendaleUSA
  3. 3.Department of PathologyOakland University William Beaumont School of MedicineRoyal OakUSA
  4. 4.Department of MedicineOakland University William Beaumont School of MedicineRoyal OakUSA
  5. 5.Division of Gastroenterology and Hepatology, Department of MedicineWilliam Beaumont Hospital at Royal OakRoyal OakUSA

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