Difference between revisions of "Gastroesophageal junction"

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{{Endoscopic biopsies}}
 
{{Endoscopic biopsies}}
 
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{{Comprehensiveness}}
 
==Microscopic examination==
 
==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.<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 findings to look for are:
 
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*'''[[Intestinalized mucosa]]''' ([[Barret's esophagus]])
At least in absence of Barret's esophagus, look for signs of (reflux) '''esophagitis'''.
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*(Reflux) '''esophagitis'''.
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*'''Gastritis'''. {{Further|Stomach|linebreak=no}}
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*'''[[Esophageal adenocarcinoma]]'''
  
 
===Barret's esophagus===
 
===Barret's esophagus===
The main diagnostic sign of Barret's esophagus is the presence of '''goblet cells''':
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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=180>
 
<gallery mode=packed heights=180>
File:Histopathology of non-dysplastic Barret's esophagus.jpg|thumb|Histopathology of Barret's esophagus. 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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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: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, latter indicated by arrows, and having a slightly bluish color compared to the apical cytoplasm of foveolar cells.
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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. An occasional but specific sign of goblet cells is crescent shaped nuclei (seen in middle one).
 
</gallery>
 
</gallery>
  
 
{{further|Barret's esophagus}}
 
{{further|Barret's esophagus}}
  
===Esophagitis===
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{{Esophagitis}}
[[File:Histopathology of acute and chronic inflammation of the gastro-esophageal junction, annotated.jpg|thumb|190px|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:<ref name=PathologyOutlinesEsophagitis>{{cite web|url=http://www.pathologyoutlines.com/topic/esophagusreflux.html|title=Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease|author=Elliot Weisenberg|website=Pathology Outlines}} Topic Completed: 1 October 2012. Minor changes: 8 July 2020</ref>
 
*'''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.
 
*'''Basal cell hyperplasia''' exceeding 15 - 20% of the epithelial thickness.
 
*'''Stromal papillae''' reaching upper third of the epithelium.
 
*'''Ballooned squamous cells'''
 
<gallery>
 
File:Histology of an eosinophil in esophageal epithelium.jpg|thumb|180px|An intra-epithelial '''eosinophil''' (characterized by its bilobed nucleus despite scant visible eosinophilic cytoplasm)
 
</gallery>
 
  
 
===Report===
 
===Report===
{{Comprehensiveness|noheader=yes}}
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{{Moderate-begin}}Document the '''type of mucosa''':
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*If both gastric and squamous mucosa is present in the same fragment, report as "'''Gastroesophageal junctional mucosa with...'''"
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*If not, report the presence of '''squamous''' and/or '''gastric mucosa'''.{{Moderate-end}}
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Examples:
 
Examples:
 
{|class=wikitable
 
{|class=wikitable

Revision as of 08:26, 13 September 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 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.)
(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