Mikael Häggström [notes 1]
Generally, the main finding to look for in biopsies from the esophagus is intestinalized mucosa (Barret's esophagus), which is defined as the presence of columnar epithelium with 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.
In incomplete Barrett's esophagus, 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 on H&E stain.
Further workup of intestinalized mucosa
If intestinalized mucosa (Barret's esophagus) is present, look for dysplasia:
In this case, the area between the stratified and the intestinalized epithelium displays reactive changes, but there is no dysplasia.
Low-grade dysplasia: Simple straight but elongated tubules lined by dysplastic cells.
Low-grade dysplasia: Elongated tubules crowded together.
Low-grade dysplasia: Crowded glandular profiles lined by atypical cuboidal cells. These contain basally oriented, enlarged vesicular nuclei and prominent nucleoli.
Low-grade dysplasia: Pseudostratified epithelium, with hyperchromatic elongated nuclei occupying much of the cells.
High-grade dysplasia: The cells are cuboidal and the nuclei have lost their normal basal polarity.
High-grade dysplasia: highly dysplastic cells
Also perform a screening for esophagitis. Further information: Gastroesophageal junction
Incomplete Barret's esophagus does not need specific mention:
| (GE junction, biopsy:)|
Gastroesophageal mucosa with intestinal metaplasia, consistent with Barrett's esophagus.
Negative for dysplasia.
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