Gastroesophageal junction: Difference between revisions

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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/>
{{further|Barret's esophagus}}
{{further|Barret's esophagus}}
===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
File:Histopathology of esophageal carcinoma.jpg|Esophageal '''adenocarcinoma'''
</gallery>


===In absence of intestinalized mucosa===
===In absence of intestinalized mucosa===

Revision as of 13:40, 20 October 2020

Author: Mikael Häggström [note 1]

Microscopic examination

File:Histopathology of non-dysplastic Barret's esophagus.jpg
Histopathology of non-dysplastic Barret's esophagus (NDBE). Yellow arrow in a indicates goblet-cell-positive mucosa adjacent to the squamocolumnar junction.[1]

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 information: Barret's esophagus

In absence of intestinalized mucosa

File:Histopathology of acute and chronic inflammation of the gastro-esophageal junction, annotated.jpg
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:[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

  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. ↑ 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:10.1007/s10353-017-0504-y. ISSN 1682-8631. 
    - Fig 2- available via license: Creative Commons Attribution 4.0 International
  2. ↑ . Barrett Esophagus. Stanford University School of Medicine. Retrieved on 2020-09-01.
  3. ↑ 3.0 3.1 Dipti M. Karamchandani. Esophagus - Premalignant - Barrett esophagus. Topic Completed: 19 March 2020, Minor changes: 29 June 2020
  4. ↑ Elliot Weisenberg. Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease. Pathology Outlines. Topic Completed: 1 October 2012. Minor changes: 8 July 2020

Image sources


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