Difference between revisions of "Gastroesophageal junction"

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(+Esophagitis)
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==Microscopic examination==
 
==Microscopic examination==
 
[[File:Histopathology of non-dysplastic Barret's esophagus.jpg|thumb|Histopathology of non-dysplastic Barret's esophagus (NDBE). 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 non-dysplastic Barret's esophagus.jpg|thumb|Histopathology of non-dysplastic Barret's esophagus (NDBE). 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>]]
The main finding to look for is intestinalized mucosa (Barret's esophagus), which is defined as the presence of columnar epithelium with goblet cells.<ref>{{cite web|url=http://surgpathcriteria.stanford.edu/gi/barrett-esophagus/printable.html|title=Barrett Esophagus|website=Stanford University School of Medicine|accessdate=2020-09-01}}</ref> 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/>
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The main finding to look for is '''intestinalized mucosa''' (Barret's esophagus), which is defined as the presence of columnar epithelium with goblet cells.<ref>{{cite web|url=http://surgpathcriteria.stanford.edu/gi/barrett-esophagus/printable.html|title=Barrett Esophagus|website=Stanford University School of Medicine|accessdate=2020-09-01}}</ref> 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/>
  
 
===Further workup of intestinalized mucosa===
 
===Further workup of intestinalized mucosa===
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File:Histopathology of esophageal carcinoma.jpg|Esophageal '''adenocarcinoma'''
 
File:Histopathology of esophageal carcinoma.jpg|Esophageal '''adenocarcinoma'''
 
</gallery>
 
</gallery>
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===In absence of intestinalized mucosa===
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Look for signs of (reflux) '''esophagitis''', mainly:<ref name=PathologyOutlinesEsophagitis>{{cite web|url=http://www.pathologyoutlines.com/topic/esophagusreflux.html|title=Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease|author=Elliot Weisenberg}} Topic Completed: 1 October 2012. Minor changes: 8 July 2020</ref>
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*Inflammatory cells in the epithelial layer (mainly eosinophils, neutrophils, excess T cells).
 +
*Basal cell hyperplasia exceeding 15 - 20% of the epithelial thickness.
  
 
===Report===
 
===Report===

Revision as of 18:40, 28 September 2020

Author: Mikael Häggström [note 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 workup of intestinalized mucosa

If intestinalized mucosa (Barret's esophagus) is present, look for dysplasia:

In absence of intestinalized mucosa

Look for signs of (reflux) esophagitis, mainly:[4]

  • Inflammatory cells in the epithelial layer (mainly eosinophils, neutrophils, excess T cells).
  • Basal cell hyperplasia exceeding 15 - 20% of the epithelial thickness.

Report

Examples:

Gastroesophageal junctional mucosa with chronic inflammation and reactive changes, non-specific.
Negative for intestinalized (Barrett's) mucosa.
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. Topic Completed: 1 October 2012. Minor changes: 8 July 2020

Image sources