Difference between revisions of "Esophagus"

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Esophagus (view source)

Revision as of 03:15, 24 October 2013

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→‎Barrett esophagus: split-out
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=Preneoplastic=
=Preneoplastic=
==Barrett esophagus==
==Barrett esophagus==
:''Intestinal metaplasia of the esophagus'' redirects here.
{{Main|Barrett esophagus}}
*Abbreviated ''BE''.
===General===
*Diagnosis is made by '''clinicans ''not'' pathologists'''.
**A common histologic correlate is metaplastic transformation of stratified squamous epithelium to simple columnar epithelium with goblet cells.
***There is disagreement whether goblet cells are required for the diagnosis.<ref name=pmid19623166>{{Cite journal  | last1 = Riddell | first1 = RH. | last2 = Odze | first2 = RD. | title = Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead? | journal = Am J Gastroenterol | volume = 104 | issue = 10 | pages = 2588-94 | month = Oct | year = 2009 | doi = 10.1038/ajg.2009.390 | PMID = 19623166 }}</ref>
****One large study suggests that goblets cells are only absent due to undersampling.<ref name=pmid21959311>{{Cite journal  | last1 = Chandrasoma | first1 = P. | last2 = Wijetunge | first2 = S. | last3 = DeMeester | first3 = S. | last4 = Ma | first4 = Y. | last5 = Hagen | first5 = J. | last6 = Zamis | first6 = L. | last7 = DeMeester | first7 = T. | title = Columnar-lined esophagus without intestinal metaplasia has no proven risk of adenocarcinoma. | journal = Am J Surg Pathol | volume = 36 | issue = 1 | pages = 1-7 | month = Jan | year = 2012 | doi = 10.1097/PAS.0b013e31822a5a2c | PMID = 21959311 }}</ref>
*Associated with (chronic) [[gastroesophageal reflux disease]].
 
Significance of Barrett's esophagus:
*Increased risk of adenocarcinoma of the esophagus.
**Need on-going surveillance, i.e. long term follow-up/repeat esophagogastroduodenoscopy.
 
===Gross===
*Red/light brown esophageal mucosa.
**Normal mucosa = light pink.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Barretts_esophagus.jpg Endoscopic image of BE (WC)].
 
===Microscopic===
Features:
*Columnar epithelium with:
**Goblet cells - '''key feature'''.
**+/-Moderate chronic inflammation +/- acute inflammation -- common.<ref name=pmid10566710>{{Cite journal  | last1 = Voutilainen | first1 = M. | last2 = Färkkilä | first2 = M. | last3 = Mecklin | first3 = JP. | last4 = Juhola | first4 = M. | last5 = Sipponen | first5 = P. | title = Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease. The Central Finland Endoscopy Study Group. | journal = Am J Gastroenterol | volume = 94 | issue = 11 | pages = 3175-80 | month = Nov | year = 1999 | doi = 10.1111/j.1572-0241.1999.01513.x | PMID = 10566710 }}</ref>
**+/-Mild nuclear hyperchromasia.
*+/-Squamous epithelium with changes of [[gastroesophageal reflux disease|gastroesophageal reflux]].
 
DDx:
*[[Chronic gastritis]].
*[[Helicobacter gastritis]].
*[[Low-grade columnar dysplasia of the esophagus]].
 
====Images====
<gallery>
Image:Barretts_alcian_blue.jpg | Barrett's type mucosa. [[Alcian blue stain]]. (WC)
Image:Barrett's_mucosa,_PAS-Alcian_blue_stain.jpg | Barrett's type mucosa. Alcian blue stain. (WC/AFIP)
Image:Barrett's_mucosa,_higher_magnification,_Alcian_blue_stain_.jpg | Barrett's type mucosa. Alcian blue stain. (WC/AFIP)
</gallery>
 
===Stains===
*Alcian blue (pH 2.5)<ref name=pmid10517897>{{Cite journal  | last1 = Voutilainen | first1 = M. | last2 = Färkkilä | first2 = M. | last3 = Juhola | first3 = M. | last4 = Mecklin | first4 = JP. | last5 = Sipponen | first5 = P. | title = Complete and incomplete intestinal metaplasia at the oesophagogastric junction: prevalences and associations with endoscopic erosive oesophagitis and gastritis. | journal = Gut | volume = 45 | issue = 5 | pages = 644-8 | month = Nov | year = 1999 | doi =  | PMID = 10517897 |URL = http://gut.bmj.com/content/45/5/644.full }}</ref> - goblet cells +ve.
 
===Sign-out===
<pre>
ESOPHAGUS, DISTAL, BIOPSY:
- COLUMNAR EPITHELIUM WITH INTESTINAL METAPLASIA AND MILD ACUTE INFLAMMATION, SEE COMMENT.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
 
COMMENT:
The findings are consistent with Barrett's esophagus in the appropriate endoscopic setting.
</pre>
 
<pre>
ESOPHAGUS, DISTAL, BIOPSY:
- COLUMNAR EPITHELIUM WITH INTESTINAL METAPLASIA AND MODERATE CHRONIC INFLAMMATION, SEE COMMENT.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR DYSPLASIA AND MALIGNANCY.
 
COMMENT:
The findings are consistent with Barrett's esophagus in the appropriate endoscopic setting.
</pre>
 
<pre>
ESOPHAGUS, DISTAL, BIOPSY:
- COLUMNAR EPITHELIUM WITH EXTENSIVE INTESTINAL METAPLASIA, ACUTE AND CHRONIC INFLAMMATION;
- SEE COMMENT.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR DYSPLASIA AND MALIGNANCY.
 
COMMENT:
The columnar epithelium with intestinal metplasia is seen located deep to the squamous
epithelium.
 
The findings are consistent with Barrett's esophagus in the appropriate endoscopic setting.
</pre>


=Neoplastic=
=Neoplastic=
Michael
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