GERD and EoE (Gupta/Howden)

Question 1

What is shown here?

Answer 1

This is an esophagus with linear areas of redness where the stomach meets the esophagus

Question 2

What is shown on the left and of the right here?
• Key features?

Answer 2

Left: Normal Esophagus
Right: GERD Esophagus

Key Features:
• Eosinophils
• Basal Cell Hyperplasia
• Papillae Extend Further up
• Inflammation/Edema
• Sub epithelial Vascular Dilation

Note: Eosinophils are shown in this tissue below

Question 3

What is seen in the Left and Right Images?
• Key difference?

Answer 3

Question 4

What is shown here?

Answer 4

Barrett’s Esophagus - salmon pink mucosa extending up from LES

Question 5

What is shown here? (tissue is from LES region)
• Key features?

Answer 5

Barrett’s Esophagus
• Goblet Cells and Columnar Cells (Interstinal Mucosa)

**Note: the Far right is normal tissue

Question 6

What is shown in this tissue taken from the esophagus?
• Key features?

Answer 6

This is low grade dysplasia
• CELLS are NOT MATURING as they Ascend into the tissue
• Nuclei/Cells are stacking

Question 7

What is shown in this tissue taken from the esophagus?
• key features?

Answer 7

High Grade Dysplasia => Glands Start MELTING Together

Question 8

What is the major protein/Gene that is important in the progression of metaplastic esophageal tissue to DYSplastic esophageal tissue?

Answer 8

P53

Question 9

Where do Cells have to be in the GI tract for them to be considered Metastatic?

Answer 9

In the SUBmucosa - there are no real lymphatics in the lamina propria

Question 10

What is shown here? (Tissue from near the LES)
• Key Features?

Answer 10

High Grade Dysplasia in the esophagus
• CRIBIFORM ARCHITECTURE tells you its high grade
• Also high N/C ratio and Hyperchromsia
• Glands and mashing together

Question 11

What is shown here? (Tissue from LES)
• Key Features?

Answer 11

LOW Grade Dysplasia
• High N/C
• Lack of Maturation
• Cell/Nuclear Stacking
• Cigar shaped nuclei

Question 12

What is shown here? (taken from Esophagus)
• key features?

Answer 12

Esophageal Adenocarcinoma (almost always associated with Barrett’s Esophagus)

Features;
• Cribiforming Structure, Necrosis, Lack of Cellular Maturation

Question 13

What is the precursor to most cases of esophageal adenocarcinoma?
• Risk Factors?
• Prognosis?

Answer 13

Precursor to Adenocarcinoma:
• Barrett’s Esophagus (remember that only 1/300 will get cancer)

Risk Factors:
• Obestiy
• Radiation

Prognosis:
• POOR - often metastatic to lymph by the time it is caught (25% % yr survival); if caught while still in mucosa/submucosa 80% 5yr survival

Question 14

Differentiate the typical location of Esophageal Adenocarcinoma and Esopageal SCC.

Answer 14

Adenocarcinoma (on front) - typically distal (LES/gastric cardia)

SCC (shown here) - typically mid esophagus => Patients may complain of difficulty swallowing because it can cause stricture

Question 15

Who most commonly presents with SCC of the esophagus?
• Risk Factors?

Answer 15

Most often its a ¹45 year old ²African American ³male

Risk Factors:
• EtOH, Tobacco, Poverty, Caustic Injury (fermented milk), Achalasia
• 5-10 years AFTER RADIATION EXPOSURE

Question 16

SCC of the Esophagus