GI Pathology: Esophagus Flashcards
1
Q
What are the layers to the normal esophageal histology?
A
- E- Epithelium
- LP- lamina propria
- MM- muscularis mucosae
- EMG- esophageal mucuc glands
- only distal 1-2 cm has serosa, remainder has adventitia only
2
Q
What is ectopia?
A
- heterotopia
- normal tissue in an abnormal location
3
Q
What type of ectopia is shown in the provided image?
A
gastric ectopia in esophagus
4
Q
What type of ectopia is shown in the image?
A
pancreatic ectopia in eophagus
5
Q
What type of ectopia is shown in the image?
A
Sebaceous ectopia in esophagus
6
Q
What is atresia? What is a fistula?
How common are they?
When are they usually discovered?
A
- Atresia
- condition in which an orifice or passage in the body is (usually abnormally) closed or absent
- Fistula
- abnormal connection between two body parts
- can occur together
- uncommon
- discovered shortly after birth
- most imcompatible with life without prompt repair
- symptoms
- regurgitation, aspiration, suffocation, pneumonia
- may be associated with other gastrointestinal, genitourinary or cardiac malformations
7
Q
What is shown in the provided image?
A
8
Q
How can you differentiate between esophageal webs vs. rings?
A
9
Q
What is esophageal stenosis?
A
10
Q
What is achlasia?
symptoms?
primary vs. secondary
A
- motility disorder – functional form of obstruction
- Triad of
- incomplete lower esophageal sphinceter (LES) relaxation
- Increased LES tone
- Aperistalisis of the esophagus
- Symptoms
- dysphagia for solids adn liquids
- difficulty in belching
- chest pain
- mild increased risk fro esophageal cancer
- may contribute to diverticula (as w/ all motilty disorders)
- Primary vs. secondary
11
Q
What is the name for outpouchings of the alimentary tract containing one or more layers of the wall?
A
Esophageal Diverticula
12
Q
What are the 3 types of diverticula?
A
- Zenker diverticulum
- pharyngoesophageal diverticulum in upper esophagus
- Traction diverticulum
- near the midpoint of the esophagus
- Epiphrenic diverticulum
- immediately above the lower esophageal sphincter, typically above hiatal hernia
13
Q
What type of diverticulum is shown in the provided image?
A
Zenker dierticulum
14
Q
What is shown in the provided image?
A
Esophageal varices
15
Q
What are the two types of esophageal lacerations?
Causes & characteristics?
A
- Mallory-Weiss
- longitudinal mucosal tears in distal esophagus/proximal stomach
- may cause UGI bleed
- violent retching/vomiting after alcohol consumption
- presence of hiatial hernia may increase risk
- Boerhaave Syndrome
- post emetic rupture of esophagus
- often preceding surgical precedure
- mediastinitis, sever chest pain
- acute UGI bleed NOT typical
16
Q
What are the possible caues for esophagus caustic injury?
A
- causes
- chemical injury
- alcohol, corrosive acids/alkalis, excessively hot liquid, heay smoking
- children
- accidental ingestion of cleaning products
- other
- suicide attempt
- chemo/TR, GVHD
- mild
- pill esophagitis
- symptoms
- odynophagia, hemorrhage, stricture, perforation
- histology
- varies depending on severity
- PMS, Eos (pills), full thickness tissue necrosis
17
Q
What is shown in the provided images?
A
- candida esophagitis
- grey-white pseudomembrane
- budding yeast, pseudohyphae
18
Q
What is shown int he provided images
A
HSV esophagitis
- punched out ulcers
- multinucleated cells with HSV nuclear inclusions
19
Q
What is shown in the provided image?
A
CMV Esophagitis
- Linear ulcers
- Endothelial cells with nuclear inclusion
20
Q
Most common demographic to have reflux esophagitis?
Symptoms?
Predisposing factors?
Treatment?
A
- most frequent in >40 y/o & infants
- symptoms
- heartburn, dysphasia, regurgitation of sour-tasting gastric contents
- most common cause esophagitis & most common outpatient GI diagnosis in US
- predisposing factors
- increased intraabdominal presure and relaxation of LES
- obesiy, EtOH, Tob, CNS depressants
- 10-15% risk developing Barret esophagus
- Treatment
- often responds to PPIs
21
Q
What is shown in the provided image?
A
22
Q
What is a hiatal hernia?
Is it common?
symptoms?
A
- sac-like dilation of stomach and herniation of proximal stomach above the diaphragm
- very common
- incidence increases wtih age
- symptoms (in present) are similar to GERD
23
Q
What is eosinophilic esophagitis?
A
- allergic disorder
- often concurrent allregic disorders
- marked increase in incidence in the past decade
- Symptoms
- children/infants
- feeding difficulty, nausea, vomiting
- adults
- solid food dysphagia, chest pain, food impaction, upper abdominal pain
- children/infants
- Treatment
- normal pH studies
- not completely responsive to PPI
- NO cancer risk
24
Q
What is shown on the provided image?
A
Eosinophilic Esophagitis
25
Describe the transition in the development of Barret Esophagus
26
What is Barrett Esophagus?
demographic?
criteria?
* A pre-malignant condition occurring in 10-20% of patietns with reflux, with rising incidence
* classic demographic
* 55y/o overweight white male with long standing GERD
* Criteria:
* Endoscopic evidence of glandular mucosa above GE junction (salmon patch)
* Biopsy evidence or intestinal metaplasia
* with goblet cells
27
What is the risk associated with barrett esophagus?
* increased risk of esophageal adenocarcinoma
* potential for progression to low grade adn high grade dysplasia
* develops in 0.2%-2.0% of persons with Barrett esophagus per year
* higher risk with longer segments and longer duration
* Shared mutations between Barrett esophagus adn adenocarcinoma
* increasing oncogenic mutations with development of dysplasia
* vast majority of esophageal adenocarcinomas associated with Barrett esophagus, but most patients with Barrett esophagus do NOT develop adenocarcinoma
28
What is shown in the provided image?
Barret Esophagus
29
What is shown in the provided image
30
What progression is shown by the images?
Barrett esophagus progressing to dysplasia and cancer
31
Where does adenocarcinoa of the esophagus occur most commonly?
How common is it?
What is the clinical diagnosis?
What increases risk?
Decreases risk?
* dista esophagu
* most rapily increasing tumor incidence in US
* increased 450% in last 20 years
* Symptoms
* GERD symptoms (or not)
* dyspepsia
* dysphagia
* odynophagia
* weight loss
* chest pain
* hematemesis
* vomiting
* Increases risk
* onl 1-5% patients with BE develop adenocarcinoma
* anything that worsens reflux esophagitis
* tobacco
* Decreases risk
* diets rich in fresh fruits and vegetables
* ceratin strains of H. Pylori infection
* gastric atrophy
* decreased acid production
32
Early markers of adenocarcinoa?
Late markers?
Prognosis is directly related to what variable?
* Early
* TP53 mutation
* CDKN2A (p16/INK4a) down regulation
* Late
* EGFR
* HER2
* MET
* cyclin D1
* E gene amplification
* Prognosis
* directly related to depth of wall invasion and lymph dnode status
* advanced stage overall 5 years 15-25%
* intramucosal or submucosal tumores 5 yrs ~80%
33
What is shown in the provided image?
advanced GE junction adenocarcinoma with liver mets
34
What are the causes of squamous cell carcinoma?
* incidence varies widely worldwide, implicating dietary and environmental factors
* occurs in mid esophagus
* risk factors
* adults over 45
* 4:1 M/F
* 8:1 AA/C
* In US
* alcohol & tobacco synergistic risk factors
* poverty, caustic injury, medaistinal RT, achalasia, Plummer-Vinson syndrome, hot beverage consumption, polycyclic hydrocarbons, nitrosamines, mutagens in fungus containing food, HPV, nonepidermolytic palmoplantar keratoderma
35
What is shown in the provided image?
squamous cell carcinoma
36
What is shown in the provided image
Squamous cell carcinoma esophagus
37
Prognosis of Squamous cell carcinoma of the esophagus?
* stage at diagnosis directly linked to prognosis
* superficially invasice (uncommonly detected) ~75% 5 years
* much lower if more advanced
* node mets - poor prognosis
* overall 5 year US survival: \<20%
