On endoscopy, which lesion is most suggestive of lymphatic dilation?

• A. White pinpoint to rice grain-like lesions
• B. Erythematous patches with ulcers
• C. Pedunculated polyps
• D. Cobblestone mucosal pattern

Answer: (A)

White pinpoint to rice grain–like lesions on endoscopy reflect dilated lymphatic channels in the mucosa, which is what lymphatic dilation (lymphangiectasia) looks like endoscopically. Those tiny white spots correspond to lymphatic vessels that have become enlarged and filled, giving a pale, dot-like appearance. This pattern is the most characteristic finding pointing toward lymphatic dilation.

Erythematous patches with ulcers suggest inflammatory or infectious mucosal damage rather than lymphatic dilation. Pedunculated polyps are mucosal growths, not lymphatic vessels. A cobblestone mucosal pattern indicates chronic transmural inflammation, as seen in Crohn disease, not lymphatic dilation.