Esophagus pathology Flashcards
Review the 4 layers of the esophagus
Review normal esophagus layers
Basal cells normally 3 cells thick. More than that suggest injury
Papillae should be half thickness of squamous epithelium; when it extends to surface, that’s a reactive sign of injury
Review the epithelium at GEJ
Gastric cardia >> columnar epithelium
Distal esophagus >> squamous epithelium
What are the types of tracheoesophageal abnormalities? (3)
Pure Esophageal atresia
Pure tracheoesophageal fistula
Esophageal atresia w/ distal tracheoesophageal fistula
The slide below is characteristic of which esophageal dysmotility disorder?
Achalasia
**remember that the lost neurons are inhibitory, that’s why you have hypertrophic nerves/increased LES tone**
What is the pathology below?
Candida esophagitis
*endoscopy: fibrinopurulent exudate, whitish-yellow plaques
presents w/ dysphagia, odynophagia
**notice inflammation, and increased papillae thickness**
*usually immunocompromised*
(can also visualize on GMS stain)
___ is characterized by sharply punched out ulcers on gross pathology, and neutrophils w/ Cowdry A inclusions, multinucleation, margination and molding
Herpes esophagitis is characterized by sharply punched out ulcers on gross pathology, and neutrophils w/ Cowdry A inclusions, multinucleation, margination and molding
**pts are immunocompromised**
What is the pathology below?
Herpes esophagitis
What is the pathology below?
Herpes esophagitis
You evaluate a pt for esophagitis as the pt presents w/ dysphagia and odonyphagia. You take a biopsy of the pts esophagus and discover ulcers w/ surrounding inflammation, as well as inclusions in the stromal and endothelial cells. There are also owl eye inclusions in the nuclei of the cells.
What is on your differential?
CMV esophagitis
What is the pathology below?
CMV esophagitis
**note owl eyes and ulcerations w/ inflammation**
A young pt (4 yo) presents w/ dysphagia, feeding intolerance, symptoms of esophageal reflux and has a history of asthma. You do a biopsy for this patient and you find >15/high power field eosinophils clustering near the surface of the squamous epithelium. On endoscopy you also see linear furrows (rings)
What is the diagnosis?
Eosinophilic esophagitis
What is the pathology below?
Mild GERD
**notice the increase in purple, i.e. increased basal cell thickness, elongated papilla and diffuse eosinophils**
You are evaluating a biopsy for a pt with chronic GERD. Biospy shows goblet cells/columnar epithelium. You also do an endoscopy for the pt, which reveals salmon-colored mucosa.
What is the diagnosis?
Barrett’s esophagus
What condition is ass’d w/ the pathology below?
Barret’s esophagus
T/F: Low and high grade dysplasia Barret’s esophagus both metastasize
What is the difference between intramucosal carcinoma and invasive adenocarcinoma?
Falsehood. Low and high grade dysplasia in Barret’s does not metastasize
Intramucosal carcinoma is invasion into the lamina propria/muscularis mucosa but has a much lower risk of metastasis; treated w/ mucosal resection
Invasive adenocarcinoma is invasion into submucosa that carries a higher risk of metastasis and may require esophagectomy
Where in the esophagus are all these esophageal disorders most likely to occur?
Distal esophagus
Distal esophagus
Distal esophagus
What is the pathology below?
Esophageal Adenocarcinoma
What is the pathology below?
Adenocarcinoma
Where in the esophagus does squamous cell carcinoma and adenocarcinoma occur?
Squamous cell carcinoma occurs in the middle esophagus whereas adenocarcinoma occurs in the distal esophagus
**squamous cell carcinoma arises from squamous epithelium - see slide 46 and 47**
Keratin pearls! Keratin pearls!
A 60 year old patient presents with worsening dysphagia. An endoscopy is performed which shows nests of atypical keratinizing squamous epithelium in desmoplastic stroma. Which of the following is true?
A.The patient likely has long standing reflux
B.The lesion arose in the setting of intestinal metaplasia
C.The lesion is present at the gastroesophageal junction
D.The patient likely has a smoking or drinking history.
D. Recall that squamous cell carcinoma is ass’d w/ smoking and alcohol use
A patient is biopsied and is diagnosed with intestinal metaplasia with high grade dysplasia. Which of the following is likely true?
A.Her lesion can metastasize.
B.She likely has had long-standing reflux.
C.She is immunosuppressed
D.The lesion is in the mid esophagus.
B. This pt likely has Barret’s esopagus, which is ass’d w/ a history of longstanding GERD
