Difference between revisions of "Gastroesophageal junction"

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{{Endoscopic biopsies}}
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{{Comprehensiveness}}
 
==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>]]
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The main findings to look for are:
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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*'''[[Intestinalized mucosa]]''' ([[Barret's esophagus]])
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*(Reflux) '''esophagitis'''.
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*'''Gastritis'''. {{Further|Stomach|linebreak=no}}
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*'''[[Esophageal adenocarcinoma]]'''
  
===Further workup of intestinalized mucosa===
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===Barret's esophagus===
If intestinalized mucosa (Barret's esophagus) is present, look for dysplasia:
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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/>
<gallery mode=packed heights=200>
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<gallery mode=packed heights=180>
File:Barrett's mucosa, low-grade dysplasia.jpg|'''Low-grade dysplasia''': Simple straight but elongated tubules lined by dysplastic cells.
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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:Barrett's mucosa, low-grade dysplasia, low-power view, H&E.jpg|'''Low-grade dysplasia''': Elongated tubules crowded together.
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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.
File:Barrett's mucosa, low-grade dysplasia, H&E.jpg|'''Low-grade dysplasia''': Crowded glandular profiles lined by atypical cuboidal cells. These contain basally oriented, enlarged vesicular nuclei and prominent nucleoli.
 
File:Barrett's mucosa, low-grade dysplasia, high-power magnification.jpg|'''Low-grade dysplasia''': Pseudostratified epithelium, with hyperchromatic elongated nuclei occupying much of the cells.
 
File:Barrett's mucosa, high-grade dysplasia, high-power magnification, H&E.jpg|'''High-grade dysplasia''': The cells are cuboidal and the nuclei have lost their normal basal polarity.
 
File:Barrett's mucosa, high-grade dysplasia.jpg|'''High-grade dysplasia''': highly dysplastic cells
 
File:Histopathology of esophageal carcinoma.jpg|Esophageal '''adenocarcinoma'''
 
 
</gallery>
 
</gallery>
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{{further|Barret's esophagus}}
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{{Esophagitis}}
  
 
===Report===
 
===Report===
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{{Moderate-begin}}Document the presence or absence of junctional mucosa (both squamous and gastric mucosa).{{Moderate-end}}
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Examples:
 
Examples:
 
{|class=wikitable
 
{|class=wikitable
| Gastroesophageal junctional mucosa with chronic inflammation and reactive changes, non-specific.<br>Negative for intestinalized (Barrett's) mucosa.
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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}}
 
|}
 
|}
  
 
{|class=wikitable
 
{|class=wikitable
| Squamous mucosa, negative for significant histopathologic changes.<br>Negative for gastric mucosa or intestinalized (Barrett's) mucosa.
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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}}
 
|}
 
|}
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{{Bottom}}
 
{{Bottom}}

Revision as of 15:49, 9 April 2021

Author: Mikael Häggström [note 1]

Endoscopic biopsies   edit
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:

Barret'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.[1] The mucin usually indents the nucleus.[1]

Further information: Barret's esophagus

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:[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

Report

(Document the presence or absence of junctional mucosa (both squamous and gastric mucosa).)

Examples:

(GE junction, biopsy:)
Squamous mucosa without significant histopathologic changes.
(Negative for gastric mucosa or intestinalized (Barrett's) mucosa.)
(GE junction, biopsy:)
Gastroesophageal junctional mucosa with chronic inflammation and reactive changes(, non-specific.
Negative for 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. 1.0 1.1 Dipti M. Karamchandani. Esophagus - Premalignant - Barrett esophagus. Topic Completed: 19 March 2020, Minor changes: 29 June 2020
  2. Elliot Weisenberg. Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease. Pathology Outlines. Topic Completed: 1 October 2012. Minor changes: 8 July 2020

Image sources