Gastroesophageal junction

Author: Mikael Häggström

Endoscopic biopsies  

Mostly: Esophagus Gastroesophageal junction Stomach Gastric polyp Duodenum Colon Colorectal polyp

Microscopic examination

Histopathology of non-dysplastic Barret's esophagus (NDBE). Yellow arrow in a indicates goblet-cell-positive mucosa adjacent to the squamocolumnar junction.

The main finding to look for is intestinalized mucosa (Barret's esophagus), which is defined as the presence of columnar epithelium with goblet cells. A true goblet cell should have rounded shape, clear to bluish cytoplasmic mucin, and be randomly scattered. The mucin usually indents the nucleus. Further information: Barret's esophagus

In absence of intestinalized mucosa

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:

• 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

• 

  An intra-epithelial eosinophil (characterized by its bilobed nucleus despite scant visible eosinophilic cytoplasm)

Report

On this resource, the following formatting is used for comprehensiveness:

• Minimal depth
• (Moderate depth)
• ((Comprehensive))

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.)

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