Esophagus

From Libre Pathology
Revision as of 13:36, 12 May 2010 by Michael (talk | contribs) (create)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to navigation Jump to search

Esophagus connects the pharynx to the stomach. It is afflicted by tumours on occasion. For some reason or another, it seems everyone at SMH gets a esophageal biopsy... yet patients at SB don't have esophagi.

Normal

General:

  • Stratified squamous non-keratinized epithelium.

Normal (esophageal) squamous epithelium:

  • Should "mature" to the surface like good stratified squamous epithelium does.
    • No nuclei at luminal surface.
    • Cells should become less hyperchromatic as you go toward the lumen.
    • Mitoses should be rare and should NOT be above the basal layer.
  • Inflammatory cells should be very rare.

Diagnoses

Common

  • Normal.
  • Metaplasia (Barrett's esophagus).
  • Dysplasia.
  • Adenocarcinoma.

Less common

  • Squamous cell carcinoma.
  • Eosinophilic esophagitis.
  • Candidiasis.
  • CMV esophagitis.

Indications

  • Pyrosis = heartburn.[1]

Infection

Main article: Microorganisms

Is a relatively common problem, especially in those that live at the margins (EtOH abusers) and immunosuppressed individuals (HIV/AIDS).

Useful stains

  • PAS.
  • Gram stain.

Candidiasis

Micro

  • Worm-like micro-organisms.[2]

Image: Esophageal candidiasis - wikipedia.org.

Barrett's esophagus

Definition

  • Metaplastic transformation of stratified squamous epithelium to simple columnar epithelium with goblet cells.

Microscopy

  • Columnar epithelium.
  • Goblets cells -- key feature.

Significance

  • Increased risk of adenocarcinoma of the esophagus.

Management

  • Long term follow-up/repeat esophagogastroduodenoscopy.

Dysplasia

Classification

  • Low grade.
  • High grade.

Microscopy

  • Nuclear changes.
    • Nuclear hyperchromatism.
    • Nuclear crowding.
    • Cigar-shaped (ellipical) nuclei.
  • Nuclear changes present at surface (not only in gland crypts).[3]
    • If changes are present at the base but not at the luminal surface -- it "matures" and is not dysplasic.

Notes:

  • Changes similar to those see in colorectal tubular adenomas.
  • Presence of goblet cells is mildly reassuring its not dysplasia.[4]

Management

Low grade dysplasia.

  • Follow-up.

High grade dysplasia.

  • Endoscopic mucosal resection.[5]
  • Surgical resection ???

Eosinophilic esophagitis

Clinical:

  • Dyspepsia.
    • Often mimics gastroesophageal reflux (GERD).[6]
  • Dysphagia.[7]

Associations:

  • Atopy.[8]
  • Celiac disease.[9]
  • Oral antigens, i.e. particular foods.[6]
  • Familial association.[6]

Microscopy

Features:[10]

  • Mucosa with abundant eosinophils: > 20/HPF.
  • Basal cell hyperplasia.
  • Papillae elongated.

Treatment

  • Avoid exacerbating antigens.
  • Topical corticosteroids, e.g. fluticasone.

Cancer

General

Risks:

  • EtOH.
  • Barrett's esophagus.
  • Smoking.

Adenocarcinoma of the esophagus

General

  • Often a prognosis poor - as diagnosed in a late stage.
  • May be difficult to distinguish from adenocarcinoma of the stomach.

Tx

  • Adenocarcinoma in situ (AIS) - may be treated with endoscopic mucosal resection & follow-up.[5]
  • Surgery - esophagectomy.

IHC

Adenocarcinoma:

  • CK7+, CK20+

See also

References

  1. ↑ http://dictionary.reference.com/browse/pyrosis
  2. ↑ NEED REF.
  3. ↑ GAG Jan 2009
  4. ↑ GAG Jan 2009
  5. ↑ 5.0 5.1 Sampliner RE (March 2009). "Endoscopic Therapy for Barrett's Esophagus". Clin. Gastroenterol. Hepatol.. doi:10.1016/j.cgh.2009.03.011. PMID 19306943.
  6. ↑ 6.0 6.1 6.2 PMID 19596009.
  7. ↑ URL: http://www.medicinenet.com/eosinophilic_esophagitis/page2.htm#tocc. Accessed on: 1 December 2009.
  8. ↑ GLP P.19.
  9. ↑ PMID 19841598.
  10. ↑ GLP P.19.
Retrieved from "https://librepathology.org/w/index.php?title=Esophagus&oldid=26"