Barrett's esophagus

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Barrett's esophagus
Diagnosis in short

Esophagus with intestinal metaplasia, as seen in Barrett esophagus. H&E 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
Treatment on-going surveillance for columnar dysplasia
Intestinal metaplasia of the esophagus redirects here.

Barrett's 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.
      • There is disagreement whether goblet cells are required for the diagnosis.[1] In the United States and Canada goblet cells are required for the diagnosis. In the UK, goblet cells are not required.
        • One large study suggests that goblets cells are only absent due to undersampling.[2]
  • Associated with gastroesophageal reflux disease (GERD).
    • Considered to be a consequence of chronic GERD.[3]

Significance of Barrett's esophagus:

Gross

  • Red/light brown esophageal mucosa.
    • Normal mucosa = light pink.

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:

Images

Stains

  • Alcian blue (pH 2.5)[5] - goblet cells +ve.

Sign-out

Esophagus, Distal, Biopsy:
- Columnar epithelium with intestinal metaplasia, 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.

Block letters

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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.