Esophagus

Author: Mikael Häggström

Endoscopic biopsies  

Mostly: Esophagus Gastroesophageal junction Stomach Gastric polyp Duodenum Colon Colorectal polyp

Most common requests:

• Eosinophilic esophagitis

Subregions:

• Gastroesophageal junction, preferably also evaluate as such for lower esophagus, or where esophagus level is not specified.

This article deals with esophageal biopsies. For resections, see: Esophagus resection

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

• Minimal depth
• (Moderate depth)
• ((Comprehensive))

Microscopic evaluation

On esophageal biopsies, look at least for esophagitis:

Esophagitis

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:

• 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)

Microscopy report

Example normal report for an esophagus biopsy:

(Middle third esophagus, biopsy:) Squamous mucosa without significant histopathologic changes. ((Negative for eosinophilic esophagitis.))

Example report with signs of reflux:

(Mid esophagus, biopsy:) Squamous mucosa with reactive changes consistent with reflux. ((Negative for eosinophilic esophagitis.))

Main page

• Main page of Patholines