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| | [[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? |
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| ==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: |
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| | | | | |
| | 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 |
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| | [[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 |
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| | [[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 |
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| | - | | | - |
| | - | | | - |
| | Image | | | [[Image:Tinci%C3%B3n_hematoxilina-eosina.jpg|center|thumb|125px|Normal esophagus. (WC)]] |
| |- | | |- |
| |Barrett's esophagus | | |Barrett's esophagus |
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| | - | | | - |
| | 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 |
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| | 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.]] |
| |} | | |} |
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| |- | | |- |
| |} | | |} |
| | |
| | ====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> |
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| ==Indications== | | ==Indications== |
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| ===Herpes esophagitis=== | | ===Herpes esophagitis=== |
| ====General====
| | {{Main|Herpes esophagitis}} |
| Etiology:
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| *[[Herpes simplex virus]].
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| ====Gross/endoscopic====
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| Features:
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| *Ulcers with a "punched-out" appearance with a brown/red edge.
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| =====Images=====
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| <gallery>
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| Image:Herpes_esophagitis.JPG | Herpes esophagitis - endoscopy. (WC)
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| </gallery>
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| www:
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| *[http://library.med.utah.edu/WebPath/GIHTML/GI003.html Herpes esophagitis - gross (utah.edu)].
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| *[http://www.gastrohep.com/images/image.asp?id=648 Herpes esophagitis - endoscopy (gastrohep.com)].
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| ====Microscopic====
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| Features (3 Ms):
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| *'''M'''oulding.
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| *'''M'''ultinucleation.
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| *'''M'''argination of chromatin.
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| =====Images=====
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| <gallery>
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| Image:Herpes_esophagitis_-_very_high_mag.jpg | HSV esophagitis - very high mag. (WC/Nephron)
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| Image:Herpes_esophagitis_-_intermed_mag.jpg | HSV esophagitis - intermed. mag. (WC/Nephron)
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| </gallery>
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| | |
| ====IHC====
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| *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>
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| **Occasionally HSV-2 +ve.
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| ===Human papillomavirus esophagitis=== | | ===Human papillomavirus esophagitis=== |
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| *[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)]. |
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| =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== |
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| ==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]].
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| *Usually a clinical [[diagnosis]].
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| *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>
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| ===Gross===
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| *Prominent blood vessels in the distal eosphagus.
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| Note:
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| *At [[autopsy]] its best demonstrated by inversion of the esophagus.<ref name=Ref_HospAuto140>{{Ref HospAuto|140}}</ref>
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| Image:
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| *[http://commons.wikimedia.org/wiki/File:Esophageal_varices_-_wale.jpg Esophageal varices - endoscopy (WC)].
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| ===Microscopic===
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| Features:
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| *Large dilated submucosal [[blood vessels|veins]] - '''key feature'''.
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| *+/-Blood.
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| Image:
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| *[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>
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| ==Acute esophagitis== | | ==Acute esophagitis== |
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| ==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}} |
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| =Preneoplastic= | | =Preneoplastic= |
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| *[[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===
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| *Arises in the setting of ''[[Barrett esophagus]]''.
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| ====Classification====
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| #Indefinite for dysplasia.
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| #*[[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.
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| #Low grade dysplasia.
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| #High grade dysplasia.
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| ====Management====
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| Low grade dysplasia & indefinite for dysplasia:
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| *Follow-up.
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| High grade dysplasia:
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| *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>
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| *Surgical resection (esophagectomy).
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| ===Microscopic===
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| Features to assess:<ref name=Ref_GLP46>{{Ref GLP|46}}</ref>
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| # 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>
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| #*Lack of lighter staining at surface.
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| #*Nuclear crowding at surface.
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| #*Nuclei at the surface not smaller.
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| # Architecture - esp. at low power.
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| #* Glands not round.
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| #** Low-grade feature: gland budding.
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| #** High-grade features: cribriforming, cystic dilation, necrotic debris.
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| #* Gland density:
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| #** Increased & round - think low-grade dysplasia.
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| #** Increased & irregular - think high-grade dysplasia.
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| # Cytology, esp. at high magnification.
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| #* Nuclear abnormalities in: size, staining, shape.
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| #* Loss of "nuclear polarity" = high-grade feature
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| #** Loss of palisaded appearance, rounding-up of nuclei.
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| # Inflammation, erosions & ulceration.
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| #* Marked inflammation should prompt consideration of knocking down the diagnosis one step, i.e. low-grade becomes indefinite ''or'' high-grade becomes low-grade.
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| Negatives:
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| #No desmoplasia.
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| #*Stromal fibrotic reaction to the tumour.
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| #**Desmoplasia is rare in the superficial esophagus.<ref name=Ref_GLP49>{{Ref GLP|49}}</ref>
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| #No single cells.
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| #No extensive back-to-back glands.
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| Notes:
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| *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.
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| *Presence of goblet cells suggests it is not dysplasia.<ref>GAG. January 2009.</ref>
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| *Desmoplasia present = invasive adenocarcinoma.<ref name=Ref_GLP54>{{Ref GLP|54}}</ref>
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| *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>
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| DDx:
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| *[[Intestinal metaplasia of the esophagus]].
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| *[[Esophageal adenocarcinoma]].
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| ====Images====
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| *[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F4.html Intestinal metaplasia (nature.com)].
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| Indefinite for columnar dysplasia:
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| *[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F8.html Indefinite for columnar dysplasia (nature.com)].
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| Low-grade columnar dysplasia:
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| *[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>
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| High-grade columnar dysplasia:
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| *[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F6.html High-grade columnar dysplasia (nature.com)].<ref name=pmid19581906/>
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| *[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>
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| ===Sign out===
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| <pre>
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| ESOPHAGUS, DISTAL, BIOPSY:
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| - LOW-GRADE COLUMNAR EPITHELIAL DYSPLASIA, SEE COMMENT.
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| - COLUMNAR EPITHELIUM WITH GOBLET CELL METAPLASIA.
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| - REACTIVE SQUAMOUS EPITHELIUM.
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| COMMENT:
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| This was reviewed with Dr. X and they agree with the diagnosis.
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| </pre>
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| ====Alternate====
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| <pre>
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| ESOPHAGUS, 30 CM, BIOPSY:
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| - LOW-GRADE COLUMNAR DYSPLASIA WITH INTESTINAL METAPLASIA AND MILD CHRONIC
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| INFLAMMATION.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
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| ==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> |
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| ==Squamous cell carcinoma of the esophagus== | | ==Squamous cell carcinoma of the esophagus== |
| *[[AKA]] ''esophageal squamous cell carcinoma'', abbreviated ''esophageal SCC''. | | *[[AKA]] ''esophageal squamous cell carcinoma'', abbreviated ''esophageal SCC''. |
| {{Main|Squamous carcinoma}} | | {{Main|Squamous cell carcinoma of the esophagus}} |
| ===General===
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| *Like squamous cell carcinoma elsewhere.
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| Risk factors:<ref name=Ref_APBR104>{{Ref APBR|104 Q1}}</ref>
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| *[[Ethanol abuse|Alcohol consumption]].
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| *[[Smoking|Tobacco use]].
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| *Food with nitrosamines.
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| *Burning-hot beverages.
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| Note:
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| *Reflux is ''not'' a risk factor for esophageal SCC.
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| ===Microscopic===
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| :See ''[[Squamous carcinoma]]''.
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| Note:
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| *Just to make things confusing, the ''Staging'' of early SCC differs from that of early adenocarcinoma!
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| DDx:
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| *[[Squamous dysplasia of the esophagus]].
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| ====Images====
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| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544238/figure/fig08/ Carcinoma in situ (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>
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| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544238/figure/fig09/ Squamous cell carcinoma of the esophagus (nih.gov)].
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| ===Sign out===
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| <pre>
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| ESOPHGAUS, BIOPSY:
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| - INVASIVE SQUAMOUS CELL CARCINOMA, KERATINIZING, MODERATELY DIFFERENTIATED.
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| COMMENT:
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| Benign squamous epithelium at least partially overlies the invasive squamous
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| cell carcinoma; this may mask the true extent of the lesion on endoscopy.
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| </pre>
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| ====Micro====
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| The sections show a squamous mucosa with focal moderate atypia of the squamous cells,
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| keratinization and easily identified mitotic figures. The atypical cells are partially
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| covered by benign squamous cells, and there is a very sharp transition between the cells
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| with atypia and those without. The atypical squamous cells extend into the subepithelial tissue in irregularly shaped nests and cords. A small amount of benign muscle is present.
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|
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| ==Esophageal adenocarcinoma== | | ==Esophageal adenocarcinoma== |
| *[[AKA]] ''adenocarcinoma of the esophagus''. | | *[[AKA]] ''adenocarcinoma of the esophagus''. |
| | | {{Main|Esophageal adenocarcinoma}} |
| ===General===
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| *Often a prognosis poor - as diagnosed in a late stage.
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| *May be difficult to distinguish from adenocarcinoma of the stomach.
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| **By convention (in the ''[[CAP checklist]]'') gastroesophageal junction carcinomas are staged as esophageal carcinomas.<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Esophagus_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Esophagus_11protocol.pdf]. Accessed on: 6 April 2012.</ref>
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| ====Tx====
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| *Adenocarcinoma in situ (AIS) - may be treated with endoscopic mucosal resection & follow-up.<ref name=pmid19306943/>
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| *Surgery - esophagectomy.
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| ====Esophagus vs. stomach====
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| The convention is it's esophageal if both of the following are true:<ref name=Ref_WMSP168>{{Ref WMSP|168}}</ref>
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| #Epicenter of tumour is in the esophagus.
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| #Barrett's mucosa is present.
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| ===Microscopic===
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| Features:
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| *Adenocarcinoma:
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| **Cell clusters that form glands.
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| **Nuclear atypia of malignancy:
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| ***Size variation.
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| ***Shape variation.
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| ***Staining variation.
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| **Mitoses common.
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| =====Images=====
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| <gallery>
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| Image:Esophageal_adenocarcinoma_-_very_low_mag.jpg |Esophageal adenocarcinoma - very low mag. (WC)
| |
| Image:Esophageal_adenocarcinoma_-_intermed_mag.jpg |Esophageal adenocarcinoma - intermed. mag. (WC)
| |
| </gallery>
| |
|
| |
| ====Grading====
| |
| Graded like other adenocarcinoma:<ref name=Ref_WMSP168>{{Ref WMSP|168}}</ref>
| |
| *>95 % of tumour in glandular arrangement = ''well-differentiated''.
| |
| *95-50% of tumour in glandular arrangement= ''moderately-differentiated''.
| |
| *<50% of tumour in glandular arrangment = ''poorly-differentiated''.
| |
| | |
| ====Staging====
| |
| Early esophageal adenocarcinoma has its own staging system:<ref>{{Cite journal | last1 = Pech | first1 = O. | last2 = May | first2 = A. | last3 = Rabenstein | first3 = T. | last4 = Ell | first4 = C. | title = Endoscopic resection of early oesophageal cancer. | journal = Gut | volume = 56 | issue = 11 | pages = 1625-34 | month = Nov | year = 2007 | doi = 10.1136/gut.2006.112110 | PMID = 17938435 | PMC = 2095648 }}</ref><ref>{{Cite journal | last1 = Thosani | first1 = N. | last2 = Singh | first2 = H. | last3 = Kapadia | first3 = A. | last4 = Ochi | first4 = N. | last5 = Lee | first5 = JH. | last6 = Ajani | first6 = J. | last7 = Swisher | first7 = SG. | last8 = Hofstetter | first8 = WL. | last9 = Guha | first9 = S. | title = Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. | journal = Gastrointest Endosc | volume = | issue = | pages = | month = Nov | year = 2011 | doi = 10.1016/j.gie.2011.09.016 | PMID = 22115605 | URL = http://www.sciencedirect.com/science/article/pii/S0016510711022048 }}</ref>
| |
| *M1 = lamina propria.
| |
| *M2 = superficial muscularis mucosae.
| |
| *M3 = submucosa.
| |
| *M4 = muscularis propria.
| |
| | |
| ===IHC===
| |
| *CK7 +ve.
| |
| *CK20 +ve.
| |
| | |
| To rule-out SCC:
| |
| *p63 -ve.
| |
| *HWMK -ve.
| |
|
| |
|
| =Weird stuff= | | =Weird stuff= |
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|
| |
|
| ==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/>
| |
| | |
| ===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 775: |
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 800: |
Line 549: |
|
| |
|
| [[Category:Gastrointestinal pathology]] | | [[Category:Gastrointestinal pathology]] |
| | [[Category:Esophagus|Esophagus]] |