Gastroesophageal junction

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Author: Mikael Häggström [notes 1]

Microscopic examination

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

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