Chapter 6 - Esophagus Flashcards
What is the normal histology of the esophagus?
A nonkeratinizing squamous epithelium overlying a lamina propria and thing muscularis mucosa.
Submucosa contains lymphatics and mucous glands.
Muscularis propria and adventitia below.
What are the four changes seen in reflux esophagitis?
Basal cell hyperplasia
Elongated vascular papillae
Balloon cell change of epithelium
Intraepithelial neutrophils or eosinophils
What is the significance of a prominent neutrophilic infiltrate in the esophagus?
Suggests infection or acute injury; consider looking at PAS/GMS.
What are the usual morphologic features of esophageal candidiasis?
A superficial neutrophilic infiltrate and parakeratosis
Name some causes of esophageal ulcers.
Severe reflux
Chemical injury
Radiation
Infection
Distinguish the morphologies of HSV and CMV ulcers.
HSV: Infects epithelial cells, best seen on adjacent intact squamous mucosa, with multinucleation.
CMV: Infects mesenchymal cells at the ulcer base, causing giganic cellular inclusions.
At the distal esophagus, what is the significance of:
Gastric-type epithelium?
Pink-purple acinar cells?
Gastric-type epithelium may represent mis-targeting or a hiatal hernia.
Pink-purple acinar cells may represent normal pancreatic metaplasia/heterotopia.
What is the sine qua non of Barrett’s esophagus?
What look-alike should be ignored?
Intestinal metaplasia with goblet cells (stain blue on PAS/AB).
Gastric-type foveolar epithelium (whcih also stains blue, “tall blues”)
What are the characteristics of dysplasia within Barrett’s esophagus?
Nuclear hyperchromatism and pleomorphism
High nuclear-to-cytoplasmic ratio
Loss of mucin vacuoles
Crowding, pseudostratification, loss of polarity
*must extend from base to surface epithelium*
What are the morphologic features of high grade dysplasia in Barrett’s Esophagus, and of invasive adenocarcinoma?
High-grade dysplasia: Increasing atypia, mitotic activity, architectural dysplasia.
Ragged basement membrane, single infiltrative cells, desmoplasia.
What are the morphologic features of squamous carcinoma in situ and invasive squamous carcinoma?
Enlarged, pleomorphic nuclei, increased N/C ratio, suprabasal mitoses, loss of order and polarity.
CIS if full thickness
Invasive carcinoma: Look for deep aberrant keratinization and single cells.
What is the staging of an intramucosal esophageal adenocarcinoma?
T1; NOT TIS. Once in the LP, it is thought to have metastatic potential.
Give a differential for benign polypoid esophageal lesions.
Inflammatory fibroid polyp (vascular, inflamed, fibrous stroma resembling granulation tissue)
Fibrovascular polyp (fibrovascular core with normal lining)
Squamous papilloma (fibrovascular core with hyperplastic lining)
Submucosal nodules like leiomyoma and granular cell tumor
Normal esophagus
Arrow: Basal layer
Arrowhead: Vascular pegs
Reflux esophagitis
Arrow: Basal layer
Circle: Eosinophils
Arrowhead: Lymphocytes
Candida esophagitis.
Arrow: Yeasts and pseudohyphae
Barrett’s Esophagus
Arrow/Arrowhead: Goblet cells
Inset: PAS/AB stain highlighting goblet cells
Low-grade dysplasia in Barrett’s esophagus
Arrow/arrowheads: Dysplasia, extending to surface.
High-grade dysplasia in Barrett’s esophagus.
Arrow: Disordered growth
Arrowhead: Cribriforming
Circle: Focus suspicious for invasion
Invasive esophageal adenocarcinoma.
Asterisk: Invasive glands
Arrow: Invasive cords
Arrowhead: Invasive single cells
