Gastroesophageal junction: Difference between revisions
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===In absence of intestinalized mucosa=== | ===In absence of intestinalized mucosa=== | ||
[[File:Histopathology of acute and chronic inflammation of the gastro-esophageal junction, annotated.jpg|thumb|190px|GE junction with chronic '''esophagitis''', including plasma cells (black arrow), an acute inflammation with neutrophils (white arrow), as well as basal layer hyperplasia (yellow double-headed arrow).]] | [[File:Histopathology of acute and chronic inflammation of the gastro-esophageal junction, annotated.jpg|thumb|190px|GE junction with chronic '''esophagitis''', including plasma cells (black arrow), an acute inflammation with neutrophils (white arrow), as well as basal layer hyperplasia (yellow double-headed arrow).]] | ||
Look for signs of (reflux) '''esophagitis''', mainly:<ref name=PathologyOutlinesEsophagitis>{{cite web|url=http://www.pathologyoutlines.com/topic/esophagusreflux.html|title=Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease|author=Elliot Weisenberg}} Topic Completed: 1 October 2012. Minor changes: 8 July 2020</ref> | Look for signs of (reflux) '''esophagitis''', mainly:<ref name=PathologyOutlinesEsophagitis>{{cite web|url=http://www.pathologyoutlines.com/topic/esophagusreflux.html|title=Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease|author=Elliot Weisenberg|website=Pathology Outlines}} Topic Completed: 1 October 2012. Minor changes: 8 July 2020</ref> | ||
*'''Inflammatory cells''', especially when intra-epithelial. Neutrophils confer a diagnosis of acute inflammation, while plasma cells, eosinophils and excess T cells confer a diagnosis of chronic inflammation. | *'''Inflammatory cells''', especially when intra-epithelial. Neutrophils confer a diagnosis of acute inflammation, while plasma cells, eosinophils and excess T cells confer a diagnosis of chronic inflammation. | ||
*'''Basal cell hyperplasia''' exceeding 15 - 20% of the epithelial thickness. | *'''Basal cell hyperplasia''' exceeding 15 - 20% of the epithelial thickness. | ||
*'''Stromal papillae''' reaching upper third of the epithelium. | |||
*'''Ballooned squamous cells''' | |||
===Report=== | ===Report=== | ||
Revision as of 11:19, 20 October 2020
Author:
Mikael Häggström [note 1]
Microscopic examination
The main finding to look for is intestinalized mucosa (Barret's esophagus), which is defined as the presence of columnar epithelium with goblet cells.[2] A true goblet cell should have rounded shape, clear to bluish cytoplasmic mucin, and be randomly scattered.[3] The mucin usually indents the nucleus.[3]
Further workup of intestinalized mucosa
If intestinalized mucosa (Barret's esophagus) is present, look for dysplasia:
-
Low-grade dysplasia: Simple straight but elongated tubules lined by dysplastic cells.
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Low-grade dysplasia: Elongated tubules crowded together.
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Low-grade dysplasia: Crowded glandular profiles lined by atypical cuboidal cells. These contain basally oriented, enlarged vesicular nuclei and prominent nucleoli.
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Low-grade dysplasia: Pseudostratified epithelium, with hyperchromatic elongated nuclei occupying much of the cells.
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High-grade dysplasia: The cells are cuboidal and the nuclei have lost their normal basal polarity.
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High-grade dysplasia: highly dysplastic cells
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Esophageal adenocarcinoma
In absence of intestinalized mucosa
Look for signs of (reflux) esophagitis, mainly:[4]
- Inflammatory cells, especially when intra-epithelial. Neutrophils confer a diagnosis of acute inflammation, while plasma cells, eosinophils and excess T cells confer a diagnosis of chronic inflammation.
- Basal cell hyperplasia exceeding 15 - 20% of the epithelial thickness.
- Stromal papillae reaching upper third of the epithelium.
- Ballooned squamous cells
Report
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Examples:
| (GE junction, biopsy:) Gastroesophageal junctional mucosa with chronic inflammation and reactive changes(, non-specific. Negative for intestinalized (Barrett's) mucosa.) |
| (GE junction, biopsy:) Squamous mucosa, negative for significant histopathologic changes. (Negative for gastric mucosa or intestinalized (Barrett's) mucosa.) |
Notes
- ↑ 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
- ↑ Riegler, M.; Kristo, I.; Nikolic, M.; Rieder, E.; Schoppmann, S. F. (2017). "Update on the management of Barrett’s esophagus in Austria
". European Surgery 49 (6): 282–287. doi:. ISSN 1682-8631.
- Fig 2- available via license: Creative Commons Attribution 4.0 International - ↑ . Barrett Esophagus. Stanford University School of Medicine. Retrieved on 2020-09-01.
- ↑ 3.0 3.1 Dipti M. Karamchandani. Esophagus - Premalignant - Barrett esophagus. Topic Completed: 19 March 2020, Minor changes: 29 June 2020
- ↑ Elliot Weisenberg. Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease. Pathology Outlines. Topic Completed: 1 October 2012. Minor changes: 8 July 2020
Image sources