Basal crypt dysplasia

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Basal crypt dysplasia, abbreviated BCD, is a dysplastic change reported in the esophagus that involves the crypt bases but not the surface.[1]

It may be referred to as crypt dysplasia-like atypia[2] and crypt dysplasia (abbreviated CD).

The conventional thinking has been that dysplasia always involve the surface epithelium; BCD violates the saying normal is dark deep and light luminal. This entity is consider to be an emerging concept;[3] it is not completely without controversy.

General

  • Molecular changes in the crypt base can be identified in the surface cells.[1]
  • Strong association with conventional dysplasia/adenocarcinoma.
  • Reproducibility among pathologists is worse than high-grade dysplasia but better than low-grade dysplasia.[3]

Microscopic

Features:

  • Definite "dysplastic changes" in the crypt base:
    • Hyperchromasia - important.
    • Nuclear enlargement.
    • Nuclear crowding (pseudostratification).
  • Non-dysplastic (normal) surface epithelium.[1]

DDx:

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  • Cut levels to look for a definite lesion.
  • Probably best to avoid; call it "indefinite for dysplasia".

Note:

  • Voltaggio et al. advocate it should be treated like low-grade dysplasia (requires a follow-up biopsy).[3]

See also

References

  1. 1.0 1.1 1.2 Khan, S.; McDonald, SA.; Wright, NA.; Graham, TA.; Odze, RD.; Rodriguez-Justo, M.; Zeki, S. (Sep 2013). "Crypt dysplasia in Barrett's oesophagus shows clonal identity between crypt and surface cells.". J Pathol 231 (1): 98-104. doi:10.1002/path.4211. PMID 23695891.
  2. 2.0 2.1 Lomo, LC.; Blount, PL.; Sanchez, CA.; Li, X.; Galipeau, PC.; Cowan, DS.; Ayub, K.; Rabinovitch, PS. et al. (Apr 2006). "Crypt dysplasia with surface maturation: a clinical, pathologic, and molecular study of a Barrett's esophagus cohort.". Am J Surg Pathol 30 (4): 423-35. PMID 16625087.
  3. 3.0 3.1 3.2 Voltaggio, L.; Montgomery, EA.; Lam-Himlin, D. (Oct 2011). "A clinical and histopathologic focus on Barrett esophagus and Barrett-related dysplasia.". Arch Pathol Lab Med 135 (10): 1249-60. doi:10.5858/arpa.2011-0019-RA. PMID 21970480.