Gastroesophageal junction: Difference between revisions

From patholines.org
Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Mikael Häggström (talk | contribs)
Administrators, Editors, Image-reviewer, csmoderator, Interface administrators, Administrators, Upload Wizard campaign editors
7,148 edits
m →Report: Consistent
Mikael Häggström (talk | contribs)
Administrators, Editors, Image-reviewer, csmoderator, Interface administrators, Administrators, Upload Wizard campaign editors
7,148 edits
Line 6: Line 6:


==Microscopic examination==
==Microscopic examination==
[[File:Histopathology of non-dysplastic Barret's esophagus.jpg|thumb|Histopathology of non-dysplastic Barret's esophagus (NDBE). Yellow arrow in a indicates goblet-cell-positive mucosa adjacent to the squamocolumnar junction.<ref>{{cite journal|last1=Riegler|first1=M.|last2=Kristo|first2=I.|last3=Nikolic|first3=M.|last4=Rieder|first4=E.|last5=Schoppmann|first5=S. F.|title=Update on the management of Barrett’s esophagus in Austria|journal=European Surgery|volume=49|issue=6|year=2017|pages=282–287|issn=1682-8631|doi=10.1007/s10353-017-0504-y}}<br>- Fig 2- available via license: Creative Commons Attribution 4.0 International</ref>]]
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/>
At least in absence of Barret's esophagus, look for signs of (reflux) '''esophagitis'''.
===Barret's esophagus===
The main diagnostic sign of Barret's esophagus is the presence of '''goblet cells''':
<gallery mode=packed>
File:Histopathology of non-dysplastic Barret's esophagus.jpg|thumb|Histopathology of Barret's esophagus. Yellow arrow in a indicates goblet-cell-positive mucosa adjacent to the squamocolumnar junction.<ref>{{cite journal|last1=Riegler|first1=M.|last2=Kristo|first2=I.|last3=Nikolic|first3=M.|last4=Rieder|first4=E.|last5=Schoppmann|first5=S. F.|title=Update on the management of Barrett’s esophagus in Austria|journal=European Surgery|volume=49|issue=6|year=2017|pages=282–287|issn=1682-8631|doi=10.1007/s10353-017-0504-y}}<br>- Fig 2- available via license: Creative Commons Attribution 4.0 International</ref>
File:Histopathology of goblet cells (annotated) and foveolar cells in incomplete Barrett's esophagus.jpg|In '''incomplete''' intestinal metaplasia, there are both foveolar cells and goblet cells, latter indicated by arrows, and having a slightly bluish color compared to the apical cytoplasm of foveolar cells.
</gallery>
{{further|Barret's esophagus}}
{{further|Barret's esophagus}}


===In absence of intestinalized mucosa===
===Esophagitis===
[[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|website=Pathology Outlines}} 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>

Revision as of 19:31, 30 November 2020

Author: Mikael Häggström [note 1]

Endoscopic biopsies   edit
Mostly:

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.[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]

At least in absence of Barret's esophagus, look for signs of (reflux) esophagitis.

Barret's esophagus

The main diagnostic sign of Barret's esophagus is the presence of goblet cells:

Further information: Barret's esophagus

Esophagitis

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:)
Squamous mucosa without significant histopathologic changes.
(Negative for gastric mucosa or intestinalized (Barrett's) mucosa.)
(GE junction, biopsy:)
Gastroesophageal junctional mucosa with chronic inflammation and reactive changes(, non-specific.
Negative for 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
  3. ↑ 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
  4. ↑ Elliot Weisenberg. Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease. Pathology Outlines. Topic Completed: 1 October 2012. Minor changes: 8 July 2020

Image sources


Retrieved from "https://patholines.org/index.php?title=Gastroesophageal_junction&oldid=2895"