Difference between revisions of "Gastroesophageal junction"
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m (→Further workup of intestinalized mucosa: Bolded) |
(+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/> | + | 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> | ||
+ | |||
+ | ===In absence of intestinalized mucosa=== | ||
+ | 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> | ||
+ | *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]
Contents
Microscopic examination
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
- ↑ 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
- ↑ 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: . ISSN 1682-8631.
- Fig 2- available via license: Creative Commons Attribution 4.0 International - ↑ . Barrett Esophagus. Stanford University School of Medicine. Retrieved on 2020-09-01.
- ↑ 3.0 3.1 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. Topic Completed: 1 October 2012. Minor changes: 8 July 2020
Image sources