Gastroesophageal junction

Author: Mikael Häggström

Endoscopic biopsies  

Mostly: Esophagus Gastroesophageal junction Stomach Gastric polyp Duodenum Colon Colorectal polyp

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

• Minimal depth
• (Moderate depth)
• ((Comprehensive))

Microscopic examination

The main findings to look for are:

• Intestinalized mucosa (Barrett's esophagus)
• (Reflux) esophagitis.
• Gastritis. Further information: Stomach
• Esophageal adenocarcinoma

Barrett's esophagus

The main diagnostic sign of Barrett's esophagus is the presence of goblet cells. A true goblet cell should have rounded shape, clear to bluish cytoplasmic mucin, and be randomly scattered. The mucin usually indents the nucleus.

• Histopathology of Barrett's esophagus, showing intestinalized epithelium with goblet cells, as opposed to normal stratified squamous epithelium of the esophagus, and pseudostratified columnar epithelium of the fundus of the stomach. H&E stain.
  Histopathology of Barrett's esophagus, showing intestinalized epithelium with goblet cells, as opposed to normal stratified squamous epithelium of the esophagus, and pseudostratified columnar epithelium of the fundus of the stomach. H&E stain.
• In incomplete intestinal metaplasia, there are both foveolar cells and goblet cells, the latter (indicated by arrows) usually having a slightly bluish color compared to the apical cytoplasm of foveolar cells. An occasional but specific sign of goblet cells is crescent shaped nuclei (seen in middle one).
  In incomplete intestinal metaplasia, there are both foveolar cells and goblet cells, the latter (indicated by arrows) usually having a slightly bluish color compared to the apical cytoplasm of foveolar cells. An occasional but specific sign of goblet cells is crescent shaped nuclei (seen in middle one).

Further information: Barrett'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:

• 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. In eosinophil-predominant inflammation, also evaluate as suspected eosinophilic esophagitis.
• Basal cell hyperplasia exceeding 15 - 20% of the epithelial thickness.
• Stromal papillae reaching upper third of the epithelium.
• Loss of orientation of superficial epithelial cells.
• Ballooned squamous cells

• An intra-epithelial eosinophil (characterized by its bilobed nucleus despite scant visible eosinophilic cytoplasm)
  An intra-epithelial eosinophil (characterized by its bilobed nucleus despite scant visible eosinophilic cytoplasm)

Report

(Document the type of mucosa:

• If both gastric and squamous mucosa is present in the same fragment, report as "Gastroesophageal junctional mucosa with..."
• If not, report the presence of squamous and/or gastric mucosa.)

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.)

In case of multiple signs of reflux esophagitis:

(GE junction, biopsy:) Gastroesophageal junctional mucosa with changes consistent with reflux esophagitis. (Negative for intestinalized (Barrett's) mucosa.)

Main page

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