135b/137b - Pathology and Clinical Features of Esophageal Disorders Flashcards
List the histological changes seen in chronic GERD (4)
- Basal cell hyperplasia
-
Extension of vascular papillae to the top 1/2
- Due to vascular congestion
-
Inflammaotry infiltrate
- Eosinophils, lymphocytes, few neutrophils
- Ballooning of squamous cells
What defines Barrett’s Esophagus
Columnar metaplasia of the esophageal mucosa that contains intestinal metaplasia
- The esophagus is only supposed to have stratified squamous epithelium
- In Barrett’s it will contain columnar cells (columnar metaplasia) and goblet cells (intestinal metaplasia)
- Intestinal metaplasia is specifially goblet cells
What abnormality is pictured here, at the gastroesophageal junction?
What cell types would histology show?
Barrett’s esophagus
- Esophagus should be white-ish all the way until the GEJ
- White = non-keratinous stratified squamous cells
-
The pinkish stomach cells should not be present here
- These are nonciliated simple columnar cells
(gastric metaplasia) - May also contain goblet cells (intestinal metaplasia)
- These are nonciliated simple columnar cells
Which infectious esophagitis will appear with punched out ulcers?
What is the treatment?
HSV1 or HSV2
Self limited; acyclovir, valacyclovir if needed
List 3 potential complications of GERD
- Erosion/ulceration
- Strictures
- Secondary to fibrosis from ulceration
- Barrett’s esophagus
How is GERD treated?
-
Lifestyle modification = mainstay
- Smaller meals, don’t eat before bed
- Weight reduction
- Pharmoacotherapy
- Decrease acid secretion w/ H2 blocker or PP1
- Surgery is a last resort
Which parts of the esophagus are affected by GERD?
Which parts are affected by eosinophilic esophagitis?
GERD - distal
EoE - Proximal and distal
Describe the pathogenesis of Barrett’s esophagus
- Chronic GERD
- -> Inflammation, ulceration of esophageal squamous mucosa
- -> Columnar/mucinous metaplasia; mucus is protective
- This can lead to intestinal metaplasia (goblet cells)
- May develop into adenocarcinoma
What is the difference between metaplasia and dysplasia?
-
Metaplasia = transformation of one cell type into another
- Ex: Stratified squamous -> columnar in Barrett’s esophagus
- However, the new columnar cells look pretty normal
-
Dysplasia = cells are ~weird~
- Non-uniform shape, crowded, nuclear changes
- May be accumulating mutations that could be pre-cancerous
- High-grade dysplasia = carcinoma in situ
Which esophageal pathology is most strongly linked to food-antigens?
Eosinophilic esophagitis
What is the histologic hallmark of squamous cell carcinoma?
Keratin formation
Will also see:
- Nucelar hyperchromasia
- Pleomorphism (cells are not uniform)
- Increased nucleus:cytoplasm ratio
What esophageal abnormaility is pictured?
What complications may result?
Sliding hiatal hernia
(Herniation of stomach into the mediastinum through the esophageal hiatus of the diaphragm)
Predisposes to acid reflux
List 4 endoscopic findings of eosinophilic esophagitis
- Linear furrows
- Rings
- Strictures
- White patches/plaques
What kind of epithelium is this?
Where might it be found?
Non-keratinized stratified squamous epithelium
Found in places exposed to the external environment
(Esophagus, external anal canal)
List 3 histologic findings of eosinophilic esophagitis
-
Eosinophils: 15+ in 2+ high power fields, or 25+ in any one field
- Remeber, eosinophils are pink on H&E
- Basal cell hyperplasia
- Fibrosis in the lamina propria
Eosinophils and fibrosis differentiate EoE from GERD