Difference between revisions of "Esophagus"

Jump to navigation Jump to search

Esophagus (view source)

Revision as of 22:57, 27 January 2022

10,192 bytes removed ,  22:57, 27 January 2022
m
fix sp
m (fix sp)
 
(27 intermediate revisions by the same user not shown)
Line 1: Line 1:
[[Image:Tractus intestinalis esophagus.svg|thumb|250px|A schematic of the esophagus.]]
'''Esophagus''' connects the pharynx to the [[stomach]].  It is afflicted by tumours on occasion. Probably the most common affliction is [[gastroesophageal reflux disease]] (GERD). Most biopsies revolve around the questions: 1. intestinal metaplasia? 2. dysplasia? and 3. cancer?
'''Esophagus''' connects the pharynx to the [[stomach]].  It is afflicted by tumours on occasion. Probably the most common affliction is [[gastroesophageal reflux disease]] (GERD). Most biopsies revolve around the questions: 1. intestinal metaplasia? 2. dysplasia? and 3. cancer?


Line 13: Line 14:


==Sign out==
==Sign out==
===Nonspecific inflammation===
<pre>
Esophagus, Distal, Biopsy:
- Columnar epithelium with moderate chronic inflammation.
- Reactive squamous epithelium.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
====Block letters====
<pre>
<pre>
ESOPHAGUS, DISTAL, BIOPSY:
ESOPHAGUS, DISTAL, BIOPSY:
Line 56: Line 67:
|
|
| incr. risk of Barrett's
| incr. risk of Barrett's
|
| [[Image:Gastroesophageal reflux disease -- low mag.jpg|center|thumb|125px|c/w GERD. (WC)]]
|-  
|-  
|Eosinophilic esophagitis
|[[Eosinophilic esophagitis]]
| abundant eosinophils
| abundant eosinophils
| elongated (epithelial) papillae, basal cell hyperplasia, lymphocytes
| elongated (epithelial) papillae, basal cell hyperplasia, lymphocytes
Line 65: Line 76:
| [[Image:Eosinophilic_esophagitis_-_2_-_very_high_mag.jpg|center|thumb|125px|Eosinophilic esophagitis. (WC/Nephron)]]
| [[Image:Eosinophilic_esophagitis_-_2_-_very_high_mag.jpg|center|thumb|125px|Eosinophilic esophagitis. (WC/Nephron)]]
|-  
|-  
|Barrett's type change
|[[Barrett's esophagus|Barrett's type change]]
| goblet cells
| goblet cells
| no dysplasia
| no dysplasia
Line 72: Line 83:
| [[Image:Barretts_alcian_blue.jpg|center|thumb|125px|Barrett's esophagus. Alcian blue. (WC)]]
| [[Image:Barretts_alcian_blue.jpg|center|thumb|125px|Barrett's esophagus. Alcian blue. (WC)]]
|-  
|-  
|Dysplasia, low grade
|[[Columnar dysplasia of the esophagus|Dysplasia, low grade]]
| nuclear crowding at surface
| nuclear crowding at surface
| hyperchromasia, mild arch. complexity, no necrosis
| hyperchromasia, mild arch. complexity, no necrosis
|
|
| incr. risk of carcinoma
| incr. risk of carcinoma
|
| [[Image:Low-grade columnar dysplasia of the esophagus -- intermed mag.jpg|thumb|110px|LGH - intermed. mag.]]
|-  
|-  
|Dysplasia, high grade
| [[Columnar dysplasia of the esophagus|Dysplasia, high grade]]
| cribriforming and/or necrosis  
| [[cribriform]]ing and/or necrosis  
| nuclei often round & large, hyperchromasia
| nuclei often round & large, hyperchromasia
|
|
| marked incr. risk of carcinoma
| marked incr. risk of carcinoma
|
| [[Image:High-grade columnar dysplasia of the esophagus -- high mag.jpg|thumb|110px|HGD - high mag.]]
<!--
<!--
|Entity
|Entity
Line 112: Line 123:
| -
| -
| -
| -
| Image
| [[Image:Tinci%C3%B3n_hematoxilina-eosina.jpg|center|thumb|125px|Normal esophagus. (WC)]]
|-  
|-  
|Barrett's esophagus  
|Barrett's esophagus  
Line 136: Line 147:
| -
| -
| follow-up
| follow-up
| Image
| [[Image:Low-grade columnar dysplasia of the esophagus -- intermed mag.jpg|thumb|110px|LGH - intermed. mag.]]
|-  
|-  
|High-grade columnar dysplasia  
|High-grade columnar dysplasia  
Line 143: Line 154:
| moderate-to-marked nuclear atypia (usu. plump round nuclei), hyperchromasia, +/-necrosis
| moderate-to-marked nuclear atypia (usu. plump round nuclei), hyperchromasia, +/-necrosis
| -
| -
| EMR, surgery
| [[EMR]], surgery
| Image
| [[Image:High-grade columnar dysplasia of the esophagus -- high mag.jpg|thumb|110px|HGD - high mag.]]
|-  
|-  
|Intramucosal adenocarcinoma  
|Intramucosal adenocarcinoma  
| no maturation
| no maturation
| single cells or '''back-to-back irregular glands''' with budding and/or '''cribriforming''' and/or '''gland dilation''' or glands with long axis along muscularis mucosae
| single cells or '''back-to-back irregular glands''' with budding and/or '''[[cribriform]]ing''' and/or '''gland dilation''' or glands with long axis along muscularis mucosae
| moderate-to-marked nuclear atypia - usu. round large nuclei, hyperchromasia, +/-necrosis
| moderate-to-marked nuclear atypia - usu. round large nuclei, hyperchromasia, +/-necrosis
| -
| -
| EMR, surgery
| [[EMR]], surgery
| Image
| [[Image:Esophageal_adenocarcinoma_-_high_mag.jpg|thumb|110px|Adenocarcinoma - high mag.]]
|}
|}


Line 228: Line 239:
|-
|-
|}
|}
====Decision tree for columnar dysplasia====
Odze has made an algorithm - see: [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig8/ Diagnostic algorithm (nih.gov)].<ref name=pmid17021130>{{Cite journal  | last1 = Odze | first1 = RD. | title = Diagnosis and grading of dysplasia in Barrett's oesophagus. | journal = J Clin Pathol | volume = 59 | issue = 10 | pages = 1029-38 | month = Oct | year = 2006 | doi = 10.1136/jcp.2005.035337 | PMID = 17021130 }}</ref>


==Indications==
==Indications==
Line 301: Line 315:


===Herpes esophagitis===
===Herpes esophagitis===
====General====
{{Main|Herpes esophagitis}}
Etiology:
*[[Herpes simplex virus]].
 
====Gross/endoscopic====
Features:
*Ulcers with a "punched-out" appearance with a brown/red edge.
 
=====Images=====
<gallery>
Image:Herpes_esophagitis.JPG | Herpes esophagitis - endoscopy. (WC)
</gallery>
www:
*[http://library.med.utah.edu/WebPath/GIHTML/GI003.html Herpes esophagitis - gross (utah.edu)].
*[http://www.gastrohep.com/images/image.asp?id=648 Herpes esophagitis - endoscopy (gastrohep.com)].
 
====Microscopic====
Features (3 Ms):
*'''M'''oulding.
*'''M'''ultinucleation.
*'''M'''argination of chromatin.
 
=====Images=====
<gallery>
Image:Herpes_esophagitis_-_very_high_mag.jpg | HSV esophagitis - very high mag. (WC/Nephron)
Image:Herpes_esophagitis_-_intermed_mag.jpg | HSV esophagitis - intermed. mag. (WC/Nephron)
</gallery>
 
====IHC====
*HSV-1 +ve.<ref name=pmid20616659>{{Cite journal  | last1 = Canalejo Castrillero | first1 = E. | last2 = García Durán | first2 = F. | last3 = Cabello | first3 = N. | last4 = García Martínez | first4 = J. | title = Herpes esophagitis in healthy adults and adolescents: report of 3 cases and review of the literature. | journal = Medicine (Baltimore) | volume = 89 | issue = 4 | pages = 204-10 | month = Jul | year = 2010 | doi = 10.1097/MD.0b013e3181e949ed | PMID = 20616659 }}</ref>
**Occasionally HSV-2 +ve.


===Human papillomavirus esophagitis===
===Human papillomavirus esophagitis===
Line 350: Line 334:
*[http://commons.wikimedia.org/wiki/File:Low-grade_sil_and_endocx.jpg LSIL & endocervix (WC)].
*[http://commons.wikimedia.org/wiki/File:Low-grade_sil_and_endocx.jpg LSIL & endocervix (WC)].


=Other=
=Non-neoplastic disease=
The group of conditions doesn't fit neatly with the others.  It is a mixture of different non-neoplastic conditions.
The group of conditions doesn't fit neatly with the others.  It is a mixture of different non-neoplastic conditions.
==Gastroesophageal reflux disease==
==Gastroesophageal reflux disease==
Line 379: Line 363:


==Esophageal varices==
==Esophageal varices==
===General===
{{Main|Esophageal varices}}
*Arise due to [[portal hypertension]].
**This is usually due to [[cirrhosis]] that in turn is most often due to [[alcoholism]].
*Usually a clinical [[diagnosis]].
*Major cause of death in cirrhotics.<ref name=pmid21086193>{{Cite journal  | last1 = Tsochatzis | first1 = EA. | last2 = Triantos | first2 = CK. | last3 = Garcovich | first3 = M. | last4 = Burroughs | first4 = AK. | title = Primary prevention of variceal hemorrhage. | journal = Curr Gastroenterol Rep | volume = 13 | issue = 1 | pages = 3-9 | month = Feb | year = 2011 | doi = 10.1007/s11894-010-0160-x | PMID = 21086193 }}</ref>
 
===Gross===
*Prominent blood vessels in the distal eosphagus.
 
Note:
*At [[autopsy]] its best demonstrated by inversion of the esophagus.<ref name=Ref_HospAuto140>{{Ref HospAuto|140}}</ref>
 
Image:
*[http://commons.wikimedia.org/wiki/File:Esophageal_varices_-_wale.jpg Esophageal varices - endoscopy (WC)].
 
===Microscopic===
Features:
*Large dilated submucosal [[blood vessels|veins]] - '''key feature'''.
*+/-Blood.
 
Image:
*[http://www.pathguy.com/sol/15419.jpg Esophageal varix (pathguy.com)].<ref>URL: [http://www.pathguy.com/lectures/guts.htm http://www.pathguy.com/lectures/guts.htm]. Accessed on: 24 April 2013.</ref>


==Acute esophagitis==
==Acute esophagitis==
Line 407: Line 370:
==Benign esophageal stricture==
==Benign esophageal stricture==
{{Main|Esophageal stricture}}
{{Main|Esophageal stricture}}
==Esophageal duplication cyst==
{{Main|Foregut duplication cyst}}
==Zenker's diverticulum==
{{Main|Zenker's diverticulum}}
*[[AKA]] ''cricopharyngeal diverticulum'', ''pharyngoesophageal diverticulum'' and ''hypopharyngeal diverticulum''.
==Radiation esophagitis==
{{Main|Radiation esophagitis}}


=Preneoplastic=
=Preneoplastic=
Line 417: Line 390:
*[[AKA]] ''dysplasia in the columnar-lined esophagus''.<ref>{{Cite journal  | last1 = Levine | first1 = DS. | title = Management of dysplasia in the columnar-lined esophagus. | journal = Gastroenterol Clin North Am | volume = 26 | issue = 3 | pages = 613-34 | month = Sep | year = 1997 | doi =  | PMID = 9309409 }}</ref>
*[[AKA]] ''dysplasia in the columnar-lined esophagus''.<ref>{{Cite journal  | last1 = Levine | first1 = DS. | title = Management of dysplasia in the columnar-lined esophagus. | journal = Gastroenterol Clin North Am | volume = 26 | issue = 3 | pages = 613-34 | month = Sep | year = 1997 | doi =  | PMID = 9309409 }}</ref>
* [[AKA]] ''columnar epithelial dysplasia''.<ref name=pmid3825997>{{Cite journal  | last1 = Hamilton | first1 = SR. | last2 = Smith | first2 = RR. | title = The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus. | journal = Am J Clin Pathol | volume = 87 | issue = 3 | pages = 301-12 | month = Mar | year = 1987 | doi =  | PMID = 3825997 }}</ref>
* [[AKA]] ''columnar epithelial dysplasia''.<ref name=pmid3825997>{{Cite journal  | last1 = Hamilton | first1 = SR. | last2 = Smith | first2 = RR. | title = The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus. | journal = Am J Clin Pathol | volume = 87 | issue = 3 | pages = 301-12 | month = Mar | year = 1987 | doi =  | PMID = 3825997 }}</ref>
 
{{Main|Columnar dysplasia of the esophagus}}
===General===
*Arises in the setting of ''[[Barrett esophagus]]''.
 
====Classification====
#Indefinite for dysplasia.
#*[[Diagnosis]] used in the context of uncertainty (like ''[[gynecologic cytopathology|ASCUS]]'' and ''[[prostate gland|ASAP]]''); the classic reason for its use is: the surface (epithelium) cannot be seen (which precludes assessment of maturation); may be used in the context of inflammation.
#Low grade dysplasia.
#High grade dysplasia.
 
====Management====
Low grade dysplasia & indefinite for dysplasia:
*Follow-up.
 
High grade dysplasia:
*Endoscopic mucosal resection.<ref name=pmid19306943>{{cite journal |author=Sampliner RE |title=Endoscopic Therapy for Barrett's Esophagus |journal=Clin. Gastroenterol. Hepatol. |volume= |issue= |pages= |year=2009 |month=March |pmid=19306943 |doi=10.1016/j.cgh.2009.03.011 |url=}}</ref>
*Surgical resection (esophagectomy).
 
===Microscopic===
Features to assess:<ref name=Ref_GLP46>{{Ref GLP|46}}</ref>
# Lack of surface maturation - very common, occasionally absent.<ref name=pmid16625087>{{Cite journal  | last1 = Lomo | first1 = LC. | last2 = Blount | first2 = PL. | last3 = Sanchez | first3 = CA. | last4 = Li | first4 = X. | last5 = Galipeau | first5 = PC. | last6 = Cowan | first6 = DS. | last7 = Ayub | first7 = K. | last8 = Rabinovitch | first8 = PS. | last9 = Reid | first9 = BJ. | title = Crypt dysplasia with surface maturation: a clinical, pathologic, and molecular study of a Barrett's esophagus cohort. | journal = Am J Surg Pathol | volume = 30 | issue = 4 | pages = 423-35 | month = Apr | year = 2006 | doi =  | PMID = 16625087 }}</ref>
#*Lack of lighter staining at surface.
#*Nuclear crowding at surface.
#*Nuclei at the surface not smaller.
# Architecture - esp. at low power.
#* Glands not round.
#** Low-grade feature: gland budding.
#** High-grade features: cribriforming, cystic dilation, necrotic debris.
#* Gland density:
#** Increased & round - think low-grade dysplasia.
#** Increased & irregular - think high-grade dysplasia.
# Cytology, esp. at high magnification.
#* Nuclear abnormalities in: size, staining, shape.
#* Loss of "nuclear polarity" = high-grade feature
#** Loss of palisaded appearance, rounding-up of nuclei.
# Inflammation, erosions & ulceration.
#* Marked inflammation should prompt consideration of knocking down the diagnosis one step, i.e. low-grade becomes indefinite ''or'' high-grade becomes low-grade.
 
Negatives:
#No desmoplasia.
#*Stromal fibrotic reaction to the tumour.
#**Desmoplasia is rare in the superficial esophagus.<ref name=Ref_GLP49>{{Ref GLP|49}}</ref>
#No single cells.
#No extensive back-to-back glands.
 
Notes:
*Changes similar to those see in colorectal tubular adenomas; however, what would be low-grade dysplasia in the rectum is high-grade dysplasia in the esophagus.
*Presence of goblet cells suggests it is not dysplasia.<ref>GAG. January 2009.</ref>
*Desmoplasia present = invasive adenocarcinoma.<ref name=Ref_GLP54>{{Ref GLP|54}}</ref>
*Some literature suggests community pathologists should ''not'' make this call, i.e. it should be diagnosed by an expert.<ref name=pmid10385717>{{Cite journal  | last1 = Alikhan | first1 = M. | last2 = Rex | first2 = D. | last3 = Khan | first3 = A. | last4 = Rahmani | first4 = E. | last5 = Cummings | first5 = O. | last6 = Ulbright | first6 = TM. | title = Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice. | journal = Gastrointest Endosc | volume = 50 | issue = 1 | pages = 23-6 | month = Jul | year = 1999 | doi =  | PMID = 10385717 }}</ref>
 
DDx:
*[[Intestinal metaplasia of the esophagus]].
*[[Esophageal adenocarcinoma]].
 
====Images====
*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F4.html Intestinal metaplasia (nature.com)].
Indefinite for columnar dysplasia:
*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F8.html Indefinite for columnar dysplasia (nature.com)].
Low-grade columnar dysplasia:
*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F5.html Low-grade columnar dysplasia (nature.com)].<ref name=pmid19581906>{{Cite journal  | last1 = Odze | first1 = RD. | title = Barrett esophagus: histology and pathology for the clinician. | journal = Nat Rev Gastroenterol Hepatol | volume = 6 | issue = 8 | pages = 478-90 | month = Aug | year = 2009 | doi = 10.1038/nrgastro.2009.103 | PMID = 19581906 }}</ref>
High-grade columnar dysplasia:
*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F6.html High-grade columnar dysplasia (nature.com)].<ref name=pmid19581906/>
*[http://www.nature.com/ajg/journal/v104/n10/fig_tab/ajg2009390f3.html High-grade columnar dysplasia (nature.com)].<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>
 
===Sign out===
<pre>
ESOPHAGUS, DISTAL, BIOPSY:
- LOW-GRADE COLUMNAR EPITHELIAL DYSPLASIA, SEE COMMENT.
- COLUMNAR EPITHELIUM WITH GOBLET CELL METAPLASIA.
- REACTIVE SQUAMOUS EPITHELIUM.
 
COMMENT:
This was reviewed with Dr. X and they agree with the diagnosis.
</pre>
 
====Alternate====
<pre>
ESOPHAGUS, 30 CM, BIOPSY:
- LOW-GRADE COLUMNAR DYSPLASIA WITH INTESTINAL METAPLASIA AND MILD CHRONIC
  INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.
</pre>


==Squamous dysplasia of the esophagus==
==Squamous dysplasia of the esophagus==
*[[AKA]] ''eosphageal squamous dysplasia''.
*[[AKA]] ''esophageal squamous dysplasia''.
===General===
===General===
*Precursor of [[esophageal squamous cell carcinoma]].<ref name=pmid11936262>{{Cite journal  | last1 = Dry | first1 = SM. | last2 = Lewin | first2 = KJ. | title = Esophageal squamous dysplasia. | journal = Semin Diagn Pathol | volume = 19 | issue = 1 | pages = 2-11 | month = Feb | year = 2002 | doi =  | PMID = 11936262 }}</ref>
*Precursor of [[esophageal squamous cell carcinoma]].<ref name=pmid11936262>{{Cite journal  | last1 = Dry | first1 = SM. | last2 = Lewin | first2 = KJ. | title = Esophageal squamous dysplasia. | journal = Semin Diagn Pathol | volume = 19 | issue = 1 | pages = 2-11 | month = Feb | year = 2002 | doi =  | PMID = 11936262 }}</ref>
Line 615: Line 506:


==Glycogenic acanthosis of the esophagus==
==Glycogenic acanthosis of the esophagus==
===General===
{{Main|Glycogenic acanthosis of the esophagus}}
*Uncommon.
*Benign.
*Possible association with ingestion of hot liquids.<ref name=pmid20524767/>
 
===Gross/endoscopic===
*Distinctive endoscopic appearance - grey/white raised lesion.<ref name=pmid20524767>{{Cite journal  | last1 = Lopes | first1 = S. | last2 = Figueiredo | first2 = P. | last3 = Amaro | first3 = P. | last4 = Freire | first4 = P. | last5 = Alves | first5 = S. | last6 = Cipriano | first6 = MA. | last7 = Gouveia | first7 = H. | last8 = Sofia | first8 = C. | last9 = Correia-Leitão | first9 = M. | title = Glycogenic acanthosis of the esophagus: an unusually endoscopic appearance. | journal = Rev Esp Enferm Dig | volume = 102 | issue = 5 | pages = 341-2 | month = May | year = 2010 | doi =  | PMID = 20524767 | URL = http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=4618820&TO=RVN&Eng=1 }}</ref>
 
Image:
*[http://en.wikipedia.org/wiki/File:Glycogenic_acanthosis.jpg Glycogenic acanthosis (WP)].
===Microscopic===
Features:<ref name=pmid20524767/>
*Squamous epithelium with:
**Superficial clearing of the cytoplasm.
**Thickening.
 
Images:
*[http://scielo.isciii.es/pdf/diges/v102n5/carta3.pdf Glycogenic acanthosis (isciii.es)].


==Achalasia==
==Achalasia==
===General===
{{main|Achalasia}}
*Uncommon.
*Risk factor for [[squamous cell carcinoma]] (in men and women) and [[esophageal adenocarcinoma|adenocarcinoma]] (in men).<ref>{{Cite journal  | last1 = Zendehdel | first1 = K. | last2 = Nyrén | first2 = O. | last3 = Edberg | first3 = A. | last4 = Ye | first4 = W. | title = Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. | journal = Am J Gastroenterol | volume = 106 | issue = 1 | pages = 57-61 | month = Jan | year = 2011 | doi = 10.1038/ajg.2010.449 | PMID = 21212754 }}</ref>
*Due to loss of ganglion cells.<ref name=pmid24395614>{{Cite journal  | last1 = Blatnik | first1 = JA. | last2 = Ponsky | first2 = JL. | title = Advances in the Treatment of Achalasia. | journal = Curr Treat Options Gastroenterol | volume =  | issue =  | pages =  | month = Jan | year = 2014 | doi = 10.1007/s11938-013-0007-2 | PMID = 24395614 }}</ref>
 
Clinical:
*Dysphagia (difficulty swallowing) liquids ''and'' solids.<ref name=pmid24395614/>
 
DDx:
*[[Chagas disease]] - classically with Dilation of the esophagus.<ref name=pmid23317615>{{Cite journal  | last1 = Pantanali | first1 = CA. | last2 = Herbella | first2 = FA. | last3 = Henry | first3 = MA. | last4 = Mattos Farah | first4 = JF. | last5 = Patti | first5 = MG. | title = Laparoscopic Heller myotomy and fundoplication in patients with Chagas' disease achalasia and massively dilated esophagus. | journal = Am Surg | volume = 79 | issue = 1 | pages = 72-5 | month = Jan | year = 2013 | doi =  | PMID = 23317615 }}</ref>
 
===Microscopic===
Features:<ref name=pmid16128783>{{Cite journal  | last1 = Kjellin | first1 = AP. | last2 = Ost | first2 = AE. | last3 = Pope | first3 = CE. | title = Histology of esophageal mucosa from patients with achalasia. | journal = Dis Esophagus | volume = 18 | issue = 4 | pages = 257-61 | month =  | year = 2005 | doi = 10.1111/j.1442-2050.2005.00478.x | PMID = 16128783 }}</ref>
*Mucosa typically normal - even in long-standing achalasia.
 
Note:<ref name=pmid16128783/>
*Achalasia seen in the context of a resection usually has inflammation.
*Post-Heller myotomy often has inflammation.
 
===Sign out===
<pre>
ESOPHAGUS, BIOPSY:
- SQUAMOUS EPITHELIUM WITH A MILD DEEP LYMPHOCYTIC INFILTRATE, EDEMA, AND
  REACTIVE CHANGES, NO EOSINOPHILS APPARENT.
- SCANT COLUMNAR EPITHELIUM WITH MINIMAL STROMA, NO APPARENT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====Alternate====
<pre>
GASTROESOPHAGEAL JUNCTION, BIOPSY:
- COLUMNAR EPITHELIUM WITH MODERATE CHRONIC INFLAMMATION.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>


==Esophageal inlet patch==
==Esophageal inlet patch==
Line 688: Line 526:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197178/figure/fig4/ Esophageal inlet patch (nih.gov)].<ref name=pmid22091379>{{Cite journal  | last1 = Behrens | first1 = C. | last2 = Yen | first2 = PP. | title = Esophageal inlet patch. | journal = Radiol Res Pract | volume = 2011 | issue =  | pages = 460890 | month =  | year = 2011 | doi = 10.1155/2011/460890 | PMID = 22091379 }}</ref>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197178/figure/fig4/ Esophageal inlet patch (nih.gov)].<ref name=pmid22091379>{{Cite journal  | last1 = Behrens | first1 = C. | last2 = Yen | first2 = PP. | title = Esophageal inlet patch. | journal = Radiol Res Pract | volume = 2011 | issue =  | pages = 460890 | month =  | year = 2011 | doi = 10.1155/2011/460890 | PMID = 22091379 }}</ref>


==Squamous papilloma of the eosphagus==
===Sign out===
*[[AKA]] ''esophageal squamous papilloma''.
<pre>
===General===
Esophagus at 22 cm, Biopsy:
*Uncommon.
    - Gastric type mucosa with mild chronic inactive inflammation, see comment.
    - Scant unremarkable squamous epithelium.
    - NEGATIVE for intestinal metaplasia.
    - NEGATIVE for dysplasia.


===Microscopic===
Comment:
Features:
This is in keeping with an "inlet patch", also known as "heterotopic gastric mucosal patch of the proximal esophagus".
*Papillomaous projections - low power.
</pre>


====Image====
==Squamous papilloma of the esophagus==
www:
{{Main|Squamous papilloma of the esophagus}}
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544238/figure/fig03/ Squamous papilloma (nih.gov)].<ref name=pmid23330004>{{Cite journal  | last1 = Terada | first1 = T. | title = A clinicopathologic study of esophageal 860 benign and malignant lesions in 910 cases of consecutive esophageal biopsies. | journal = Int J Clin Exp Pathol | volume = 6 | issue = 2 | pages = 191-8 | month =  | year = 2013 | doi =  | PMID = 23330004 }}</ref>
<gallery>
Image:Squamous papilloma of the esophagus, HE 1.jpg|SP of the esophagus. (WC)
Image:Squamous papilloma of the esophagus, HE 2.jpg|SP of the esophagus. (WC)
</gallery>


=See also=
=See also=
Line 713: Line 549:


[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]
[[Category:Esophagus|Esophagus]]
Michael
48,466

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/30016...51823"

Navigation menu