Difference between revisions of "Gastroesophageal junction"
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− | {{Top | + | <noinclude>{{Top |
|author1=[[User:Mikael Häggström|Mikael Häggström]] | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
|author2= | |author2= | ||
}} | }} | ||
− | {{Endoscopic biopsies}} | + | {{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]]''' ([[ | + | *'''[[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]]''' | ||
− | === | + | ===Barrett's esophagus=== |
− | The main diagnostic sign of | + | 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= | + | <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. | + | 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| | + | {{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''' | + | *If not, report the presence of '''squamous''' and/or '''gastric mucosa'''.{{Moderate-end}} |
Examples: | Examples: | ||
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|} | |} | ||
− | {{Bottom}} | + | In case of multiple signs of reflux esophagitis: |
+ | {|class=wikitable | ||
+ | | {{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}} | ||
+ | |} | ||
+ | <noinclude>{{Bottom}}</noinclude> |
Latest revision as of 15:17, 6 October 2023
Author:
Mikael Häggström [note 1]
Mostly: |
Contents
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:
- Intestinalized mucosa (Barrett's esophagus)
- (Reflux) esophagitis.
- Gastritis. Further information: Stomach
- Esophageal adenocarcinoma
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]
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.
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).
Further information: Barrett's esophagus
Esophagitis
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
- ↑ 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
- ↑ 1.0 1.1 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. Pathology Outlines. Topic Completed: 1 October 2012. Minor changes: 8 July 2020
Image sources