Gastroesophageal junction: Difference between revisions

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{{Top
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{{Endoscopic biopsies}}
{{Endoscopic biopsies}}
 
{{Comprehensiveness}}</noinclude>
==Microscopic examination==
==Microscopic examination==
The main findings to look for are:
The main findings to look for are:
*'''[[Intestinalized mucosa]]''' ([[Barret's esophagus]])
*'''[[Barrett's esophagus|Intestinalized mucosa]]''' ([[Barrett's esophagus]])
*(Reflux) '''esophagitis'''.
*(Reflux) '''esophagitis'''.
*'''Gastritis'''. {{Further|Stomach|linebreak=no}}
*'''[[Esophageal adenocarcinoma]]'''


===Barret's esophagus===
===Barrett'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.<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 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.<ref name=PathologyOutlines-Barrett>{{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-Barrett/>
<gallery mode=packed heights=180>
<gallery mode=packed heights=220>
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 Barrett's esophagus, annotated.jpg|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.
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.
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, 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).
</gallery>
</gallery>


{{further|Barret's esophagus}}
{{further|Barrett's esophagus}}


{{Esophagitis}}
{{Esophagitis}}


===Report===
===Report===
{{Comprehensiveness|noheader=yes}}
{{Moderate-begin}}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'''.{{Moderate-end}}
 
Examples:
Examples:
{|class=wikitable
{|class=wikitable
| {{Moderate-begin}}GE junction, biopsy:{{Moderate-end}}<br>Squamous mucosa without significant histopathologic changes.<br>{{Moderate-begin}}Negative for gastric mucosa or intestinalized (Barrett's) mucosa.{{Moderate-end}}
| {{Moderate-begin}}GE junction, biopsy:{{Moderate-end}}<br>Squamous mucosa without significant histopathologic changes.<br>{{Moderate-begin}}Negative for gastric mucosa or intestinalized (Barrett-type) mucosa.{{Moderate-end}}<br>{{Comprehensive-begin}}Negative for dysplasia and malignancy.{{Comprehensive-end}}
|}
|}


{|class=wikitable
{|class=wikitable
| {{Moderate-begin}}GE junction, biopsy:{{Moderate-end}}<br>Gastroesophageal junctional mucosa with '''chronic inflammation''' and reactive changes{{Moderate-begin}}, non-specific.<br>Negative for intestinalized (Barrett's) mucosa.{{Moderate-end}}
| {{Moderate-begin}}GE junction, biopsy:{{Moderate-end}}<br>Gastroesophageal junctional mucosa with '''chronic inflammation''' and reactive changes{{Moderate-begin}}, non-specific.<br>Negative for intestinalized (Barrett-type) mucosa.{{Moderate-end}}{{Comprehensive-begin}}, dysplasia, and malignancy{{Comprehensive-end}}.
|}
|}


{{Bottom}}
In case of multiple signs of reflux esophagitis:
{|class=wikitable
| {{Moderate-begin}}GE junction, biopsy:{{Moderate-end}}<br>Gastroesophageal junctional mucosa with changes consistent with '''reflux esophagitis'''.<br>{{Moderate-begin}}Negative for intestinalized (Barrett-type) mucosa{{Moderate-end}}{{Comprehensive-begin}}, dysplasia, and malignancy{{Comprehensive-end}}.
|}
<noinclude>{{Bottom}}</noinclude>
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