Difference between revisions of "Barrett's esophagus"
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***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> | ***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> | ****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 | *Associated with [[gastroesophageal reflux disease]] (GERD). | ||
**Considered to be a consequence of chronic GERD.<ref name=pmid21043812>{{Cite journal | last1 = Yantiss | first1 = RK. | title = Diagnostic challenges in the pathologic evaluation of Barrett esophagus. | journal = Arch Pathol Lab Med | volume = 134 | issue = 11 | pages = 1589-600 | month = Nov | year = 2010 | doi = 10.1043/2009-0547-RAR1.1 | PMID = 21043812 }}</ref> | |||
Significance of Barrett's esophagus: | Significance of Barrett's esophagus: | ||
Revision as of 20:45, 29 November 2013
| Barrett's esophagus | |
|---|---|
| Diagnosis in short | |
 Barrett esophagus. Alcian blue stain. | |
|
| |
| LM | columnar epithelium with goblet cells |
| LM DDx | low-grade columnar dysplasia of the esophagus, gastroesophageal reflux disease, nonspecific inflammation at the GE junction |
| Stains | Alcian blue stain (pH 2.5) |
| Site | esophagus |
|
| |
| Associated Dx | gastroesophageal reflux disease, esophageal adenocarcinoma, columnar dysplasia of the esophagus |
| Prevalence | relatively common |
| Endoscopy | red/light brown esophageal mucosa, at gastro-esophageal junction |
| Prognosis | good |
- Intestinal metaplasia of the esophagus redirects here.
Barrett esophagus, abbreviated BE, is a relatively common pathology of the esophagus, that is associated with an increased risk of esophageal adenocarcinoma.
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.
- Associated with gastroesophageal reflux disease (GERD).
- Considered to be a consequence of chronic GERD.[3]
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.
Endoscopic image of BE. (WC)
Microscopic
Features:
- Columnar epithelium with:
- Goblet cells - key feature.
- +/-Moderate chronic inflammation +/- acute inflammation -- common.[4]
- +/-Mild nuclear hyperchromasia.
- +/-Squamous epithelium with changes of gastroesophageal reflux.
DDx:
- Chronic gastritis.
- Helicobacter gastritis.
- Low-grade columnar dysplasia of the esophagus.
- Carry over from a concurrent duodenal biopsy - fragments with goblets cells have no gastric-type epithelium.
Images
Barrett's type mucosa. Alcian blue stain. (WC)
Barrett's type mucosa. Alcian blue stain. (WC/AFIP)
Barrett's type mucosa. Alcian blue stain. (WC/AFIP)
Stains
- Alcian blue (pH 2.5)[5] - goblet cells +ve.
Sign-out
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.
ESOPHAGUS, DISTAL, BIOPSY: - COLUMNAR EPITHELIUM WITH INTESTINAL METAPLASIA AND MODERATE CHRONIC 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.
ESOPHAGUS, DISTAL, BIOPSY: - COLUMNAR EPITHELIUM WITH EXTENSIVE INTESTINAL METAPLASIA, ACUTE AND CHRONIC INFLAMMATION; - SEE COMMENT. - REACTIVE SQUAMOUS EPITHELIUM. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR 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.
See also
References
- ↑ Riddell, RH.; Odze, RD. (Oct 2009). "Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead?". Am J Gastroenterol 104 (10): 2588-94. doi:10.1038/ajg.2009.390. PMID 19623166.
- ↑ Chandrasoma, P.; Wijetunge, S.; DeMeester, S.; Ma, Y.; Hagen, J.; Zamis, L.; DeMeester, T. (Jan 2012). "Columnar-lined esophagus without intestinal metaplasia has no proven risk of adenocarcinoma.". Am J Surg Pathol 36 (1): 1-7. doi:10.1097/PAS.0b013e31822a5a2c. PMID 21959311.
- ↑ Yantiss, RK. (Nov 2010). "Diagnostic challenges in the pathologic evaluation of Barrett esophagus.". Arch Pathol Lab Med 134 (11): 1589-600. doi:10.1043/2009-0547-RAR1.1. PMID 21043812.
- ↑ Voutilainen, M.; Färkkilä, M.; Mecklin, JP.; Juhola, M.; Sipponen, P. (Nov 1999). "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.". Am J Gastroenterol 94 (11): 3175-80. doi:10.1111/j.1572-0241.1999.01513.x. PMID 10566710.
- ↑ Voutilainen, M.; Färkkilä, M.; Juhola, M.; Mecklin, JP.; Sipponen, P. (Nov 1999). "Complete and incomplete intestinal metaplasia at the oesophagogastric junction: prevalences and associations with endoscopic erosive oesophagitis and gastritis.". Gut 45 (5): 644-8. PMID 10517897.