Difference between revisions of "Gastroesophageal junction"

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{{Top
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<noinclude>{{Top
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author2=
 
|author2=
 
}}
 
}}
{{Endoscopic biopsies}}
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{{Endoscopic biopsies}}</noinclude>
 
{{Comprehensiveness}}
 
{{Comprehensiveness}}
 
==Microscopic examination==
 
==Microscopic examination==
 
The main findings to look for are:
 
The main findings to look for are:
*'''[[Intestinalized mucosa]]''' ([[Barret's esophagus]])
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*'''[[Barrett's esophagus|Intestinalized mucosa]]''' ([[Barrett's esophagus]])
 
*(Reflux) '''esophagitis'''.
 
*(Reflux) '''esophagitis'''.
 
*'''Gastritis'''. {{Further|Stomach|linebreak=no}}
 
*'''Gastritis'''. {{Further|Stomach|linebreak=no}}
 
*'''[[Esophageal adenocarcinoma]]'''
 
*'''[[Esophageal adenocarcinoma]]'''
  
===Barret's esophagus===
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===Barrett'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.<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 diagnostic sign of Barrett'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-Barrett>{{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-Barrett/>
<gallery mode=packed heights=180>
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<gallery mode=packed heights=220>
 
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 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, the latter (indicated by arrows) usually 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}}
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{{further|Barrett's esophagus}}
  
 
{{Esophagitis}}
 
{{Esophagitis}}
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{{Moderate-begin}}Document the '''type of mucosa''':
 
{{Moderate-begin}}Document the '''type of mucosa''':
 
*If both gastric and squamous mucosa is present in the same fragment, report as "'''Gastroesophageal junctional mucosa with...'''"
 
*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''').{{Moderate-end}}
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*If not, report the presence of '''squamous''' and/or '''gastric mucosa'''.{{Moderate-end}}
  
 
Examples:
 
Examples:
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{{Bottom}}
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In case of multiple signs of reflux esophagitis:
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| {{Moderate-begin}}GE junction, biopsy:{{Moderate-end}}<br>Gastroesophageal junctional mucosa with changes consistent with '''reflux esophagitis'''.<br>{{Moderate-begin}}Negative for intestinalized (Barrett's) mucosa.{{Moderate-end}}
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<noinclude>{{Bottom}}</noinclude>

Latest revision as of 15:17, 6 October 2023

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:

Barrett's esophagus

The main diagnostic sign of Barrett'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: Barrett'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.)

In case of multiple signs of reflux esophagitis:

(GE junction, biopsy:)
Gastroesophageal junctional mucosa with changes consistent with reflux esophagitis.
(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