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Clinical Problem Solving: Pathology
Aug 2011

Pathology Quiz Case 3

Author Affiliations
 

SECTION EDITOR: JULIA C. IEZZONI, MD

Arch Otolaryngol Head Neck Surg. 2011;137(8):831. doi:10.1001/archoto.2011.128-a

A 38-year-old woman presented with a several-year history of recurrent sore throat, globus sensation, mild dysphagia and hoarseness, increased phlegm, and loud snoring. She underwent a tonsillectomy as a child but in the last few years had experienced 3 to 4 episodes of recurrent pharyngitis each year that required treatment with antibiotics and/or oral steroids. Physical examination revealed erythematous streaks and cobblestoning of the posterior pharyngeal wall. On fiberoptic examination, the patient was found to have large lingual tonsils filling the vallecula and significant erythema and edema of the arytenoid cartilages. Omeprazole therapy (40 mg twice a day 30 minutes before meals) was initiated for presumed laryngopharyngeal reflux disease. Because of persistent symptoms 12 weeks later, the patient was started on a 300-mg bedtime dose of ranitidine and scheduled for esophagoscopy. Esophagoscopy failed to show Barrett esophagus (BE) or reflux-related esophagitis. Examination of the esophagus with white-light and narrow-band imaging revealed 3 areas of columnar epithelium just distal to the cricopharyngeus (Figure 1).

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