Gastroesophageal junction: Difference between revisions
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| {{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's) mucosa.{{Moderate-end}}<br>{{Comprehensive-begin}}Negative for dysplasia and malignancy.{{Comprehensive-end}} | ||
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| {{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's) mucosa.{{Moderate-end}}{{Comprehensive-begin}}, dysplasia, and malignancy{{Comprehensive-end}}. | ||
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In case of multiple signs of reflux esophagitis: | In case of multiple signs of reflux esophagitis: | ||
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| {{Moderate-begin}}GE junction, biopsy:{{Moderate-end}}<br>Gastroesophageal junctional mucosa with changes consistent with '''reflux esophagitis'''.<br>{{Moderate-begin}}Negative for intestinalized (Barrett's) mucosa | | {{Moderate-begin}}GE junction, biopsy:{{Moderate-end}}<br>Gastroesophageal junctional mucosa with changes consistent with '''reflux esophagitis'''.<br>{{Moderate-begin}}Negative for intestinalized (Barrett's) mucosa{{Moderate-end}}{{Comprehensive-begin}}, dysplasia, and malignancy{{Comprehensive-end}}. | ||
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<noinclude>{{Bottom}}</noinclude> | <noinclude>{{Bottom}}</noinclude> | ||
Latest revision as of 14:33, 16 July 2026
Author:
Mikael Häggström [note 1]
| Mostly: |
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.[1] The mucin usually indents the nucleus.[1]
-
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).
_and_foveolar_cells_in_incomplete_Barrett%27s_esophagus.jpg){kind=link}
Further information: Barrett's esophagus
Esophagitis
Look for signs of (reflux) esophagitis, mainly:[2]
- 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)
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.) ((Negative for dysplasia and malignancy.)) |
| (GE junction, biopsy:) Gastroesophageal junctional mucosa with chronic inflammation and reactive changes(, non-specific. Negative for intestinalized (Barrett's) mucosa.)((, dysplasia, and malignancy)). |
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)((, dysplasia, and malignancy)). |
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
- ↑ Elliot Weisenberg. Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease. Pathology Outlines. Topic Completed: 1 October 2012. Minor changes: 8 July 2020
Image sources