Esophagus Tumours

Question 1

What is Pancreatic Heterotopia/Metaplasia?

Answer 1

A condition characterized by ‘multilayered epithelium’ at the transition between squamous and glandular mucosa, resembling squamous metaplasia of the cervix.

Question 2

What is an Inlet Patch?

Answer 2

Stomach epithelium located in the upper esophagus.

Question 3

Define Complete Intestinal Metaplasia.

Answer 3

An exact duplicate of intestinal mucosa with absorptive cells between goblet cells, usually seen in the stomach.

Question 4

What characterizes Incomplete Intestinal Metaplasia?

Answer 4

Goblet cells with intervening foveolar cells, more common at the gastroesophageal junction (GEJ), and associated with a higher risk for dysplasia.

Question 5

Describe the mucosal layers of the esophagus.

Answer 5

Non-keratinizing stratified squamous mucosa leading to muscularis mucosae and submucosal glands.

Question 6

What is Barrett’s Esophagus?

Answer 6

Columnar epithelium extending ≥1 cm above the gastric folds, with or without goblet cells.

Question 7

What are the AGA and ACG criteria for Barrett’s Esophagus?

Answer 7

AGA 2011: Columnar epithelium with goblet cells (no length requirement); ACG 2016: Columnar epithelium with goblet cells extending ≥1 cm above the gastric folds.

Question 8

List some risk factors for Incomplete Intestinal Metaplasia.

Answer 8

• GERD
• Obesity
• Male gender
• Smoking
• H. pylori

Question 9

What is the pathogenesis sequence leading to cancer in the context of intestinal metaplasia?

Answer 9

Acid/bile reflux → Intestinal metaplasia → Mutations → Low-grade dysplasia → TP53 mutation → High-grade dysplasia → DNA/chromosomal instability → Cancer.

Question 10

What does ‘Negative for Dysplasia’ imply?

Answer 10

It should be the most common diagnosis.

Question 11

What are ‘The Four Lines’ indicating preserved cell polarity?

Answer 11

• Apical mucin cap
• Base of mucin cap
• Cytoplasm (between mucin and nucleus)
• Row of nuclei (maintained nuclear polarity)

Question 12

What is the significance of ‘Wild-type’ p53 staining?

Answer 12

It is used to assess potential dysplasia.

Question 13

What is the recommended management for patients with negative dysplasia?

Answer 13

Follow-up in 3-5 years.

Question 14

What does ‘Indefinite for Dysplasia’ mean?

Answer 14

Used in cases where it is unclear if there is true dysplasia, often obscured by inflammation or partial maturation.

Question 15

What is the management approach for cases with unclear dysplasia?

Answer 15

Treat for reflux and repeat biopsy in 3-6 months.