Gastroesophageal junction: Difference between revisions

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==Microscopic examination==
[[File:Barrett's mucosa, H&E.jpg|thumb|Intestinalized mucosa: Low-power view shows a predominantly columnar-lined surface epithelium, pits of gastric type, and underlying mucous glands with occasional intestinalized crypts.]]
[[File:Barrett's mucosa, H&E.jpg|thumb|Intestinalized mucosa: Low-power view shows a predominantly columnar-lined surface epithelium, pits of gastric type, and underlying mucous glands with occasional intestinalized crypts.]]


The main finding to look for is intestinalized mucosa (Barret's esophagus), which is defined as the presence of columnar epithelium with goblet cells.<ref>{{cite web|url=http://surgpathcriteria.stanford.edu/gi/barrett-esophagus/printable.html|title=Barrett Esophagus|website=Stanford University School of Medicine|accessdate=2020-09-01}}</ref> A true goblet cell should have rounded shape, clear to bluish cytoplasmic mucin, and be randomly scattered.<ref name=PathologyOutlines>{{cite web|url=http://www.pathologyoutlines.com/topic/esophagusBarrettsgeneral.html|title=Esophagus - Premalignant - Barrett esophagus|author=Dipti M. Karamchandani}} Topic Completed: 19 March 2020, Minor changes: 29 June 2020</ref> The mucin usually indents the nucleus.<ref name=PathologyOutlines/>
The main finding to look for is intestinalized mucosa (Barret's esophagus), which is defined as the presence of columnar epithelium with goblet cells.<ref>{{cite web|url=http://surgpathcriteria.stanford.edu/gi/barrett-esophagus/printable.html|title=Barrett Esophagus|website=Stanford University School of Medicine|accessdate=2020-09-01}}</ref> A true goblet cell should have rounded shape, clear to bluish cytoplasmic mucin, and be randomly scattered.<ref name=PathologyOutlines>{{cite web|url=http://www.pathologyoutlines.com/topic/esophagusBarrettsgeneral.html|title=Esophagus - Premalignant - Barrett esophagus|author=Dipti M. Karamchandani}} Topic Completed: 19 March 2020, Minor changes: 29 June 2020</ref> The mucin usually indents the nucleus.<ref name=PathologyOutlines/>


==Report==
===Further workup of intestinalized mucosa===
If intestinalized mucosa (Barret's esophagus) is present, look for dysplasia:
<gallery mode=packed heights=200>
File:Barrett's mucosa, low-grade dysplasia.jpg|Low-grade dysplasia: Simple straight but elongated tubules lined by dysplastic cells.
File:Barrett's mucosa, low-grade dysplasia, low-power view, H&E.jpg|Low-grade dysplasia: Elongated tubules crowded together.
File:Barrett's mucosa, low-grade dysplasia, H&E.jpg|Low-grade dysplasia: Crowded glandular profiles lined by atypical cuboidal cells. These contain basally oriented, enlarged vesicular nuclei and prominent nucleoli.
File:Barrett's mucosa, low-grade dysplasia, high-power magnification.jpg|Low-grade dysplasia: Pseudostratified epithelium, with hyperchromatic elongated nuclei occupying much of the cells.
File:Barrett's mucosa, high-grade dysplasia, high-power magnification, H&E.jpg|High-grade dysplasia: The cells are cuboidal and the nuclei have lost their normal basal polarity.
File:Barrett's mucosa, high-grade dysplasia.jpg|High-grade dysplasia: highly dysplastic cells
</gallery>
 
===Report===
Examples:
Examples:
{|class=wikitable
{|class=wikitable

Revision as of 12:59, 1 September 2020

Author: Mikael Häggström [note 1]

Microscopic examination

File:Barrett's mucosa, H&E.jpg
Intestinalized mucosa: Low-power view shows a predominantly columnar-lined surface epithelium, pits of gastric type, and underlying mucous glands with occasional intestinalized crypts.

The main finding to look for is intestinalized mucosa (Barret's esophagus), which is defined as the presence of columnar epithelium with goblet cells.[1] A true goblet cell should have rounded shape, clear to bluish cytoplasmic mucin, and be randomly scattered.[2] The mucin usually indents the nucleus.[2]

Further workup of intestinalized mucosa

If intestinalized mucosa (Barret's esophagus) is present, look for dysplasia:

Report

Examples:

Gastroesophageal junctional mucosa with chronic inflammation and reactive changes, non-specific.
Negative for intestinalized (Barrett's) mucosa.
Squamous mucosa, negative for significant histopathologic changes.
Negative for gastric mucosa or intestinalized (Barrett's) mucosa.

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ . Barrett Esophagus. Stanford University School of Medicine. Retrieved on 2020-09-01.
  2. ↑ 2.0 2.1 Dipti M. Karamchandani. Esophagus - Premalignant - Barrett esophagus. Topic Completed: 19 March 2020, Minor changes: 29 June 2020

Image sources


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