Gastroesophageal junction: Difference between revisions
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==Microscopic examination== | ==Microscopic examination== | ||
The main | The main findings to look for are: | ||
*'''[[Intestinalized mucosa]]''' ([[Barret's esophagus]]) | |||
*(Reflux) '''esophagitis'''. | |||
===Barret's esophagus=== | ===Barret's esophagus=== | ||
The main diagnostic sign of Barret's esophagus is the presence of '''goblet cells''': | The main diagnostic sign of Barret'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.<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/> | ||
<gallery mode=packed heights=180> | <gallery mode=packed heights=180> | ||
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 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> | ||
Revision as of 19:46, 30 November 2020
Author:
Mikael Häggström [note 1]
| Mostly: |
Microscopic examination
The main findings to look for are:
- Intestinalized mucosa (Barret's esophagus)
- (Reflux) esophagitis.
Barret's esophagus
The main diagnostic sign of Barret'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.[1] The mucin usually indents the nucleus.[1]
-
Histopathology of Barret's esophagus. Yellow arrow in a indicates goblet-cell-positive mucosa adjacent to the squamocolumnar junction.[2]
-
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.
![Histopathology of Barret's esophagus. Yellow arrow in a indicates goblet-cell-positive mucosa adjacent to the squamocolumnar junction.[2]](/index.php?title=Special:Upload&wpDestFile=Histopathology_of_non-dysplastic_Barret%27s_esophagus.jpg){kind=link}
_and_foveolar_cells_in_incomplete_Barrett%27s_esophagus.jpg){kind=link}
Further information: Barret's esophagus
Esophagitis
Look for signs of (reflux) esophagitis, mainly:[3]
- 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
-
An intra-epithelial eosinophil (characterized by its bilobed nucleus despite scant visible eosinophilic cytoplasm)
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
- ↑ 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
- ↑ 1.0 1.1 Dipti M. Karamchandani. Esophagus - Premalignant - Barrett esophagus. Topic Completed: 19 March 2020, Minor changes: 29 June 2020
- ↑ 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 - ↑ Elliot Weisenberg. Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease. Pathology Outlines. Topic Completed: 1 October 2012. Minor changes: 8 July 2020
Image sources