GI Pathology II: Esophagus Flashcards by B -

What is the location of smooth and striated muscle in the esophagus?

Striated in the upper 2/3

Smooth in the lower 1/3

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What are the most common cancers related to the esophagus?

Squamous cell carcinoma

- Adenocarcinoma

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What are the risk factors for esophageal SCC?

Alcohol and tobacco

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What are the risk factors for esophageal adenocarcinoma?

Barrett’s esophagus, alcohol and obesity

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What is a medical emergency that is associated with massive hematemesis followed by retching and vomiting?

Boerhaave Syndrome

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What is the histological criteria for Barrett’s esophagus?

Goblet cells - evidence of intestinal metaplasia

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What are the 2 most common viruses and the 1 most common fungus causing infectious esophagitis?

Viral - HSV and CMV

Fungal - Candida

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Is there diffusion of nutrients in the esophagus?

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What are the epithelial cell type in the esophagus?

Nonkeratinized Stratified Squamous Epithelium

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What is the layer under the squamous epithelium in the esophagus?

Lamina propria

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What are the epithelial cells of the stomach?

Columnar epithelium

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A G2P1 36 year old female delivers a full term male neonate. Absence of stomach gas on 36 week prenatal ultrasound was noted along with other abnormalities. At first feeding, the patient begins drooling, chocking and vomiting and becomes cyanotic. When a nasogastric tube is attempted, it will not pass into the stomach. Unfortunately, the baby expires. The X‐ray and autopsy findings are as follows on next slide. What is likely the cause of death in this patient?

A. pneumonia secondary to repeated aspiration
B. cardiac abnormality
C. obstruction from “olive” shaped palpable mass in epigastric region
D. seizure
E. metabolic acidosis secondary to starvation

B. cardiac abnormality

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Esophageal Atresia

Thin segment of the esophagus is a blind pouch and closed off separate from the second segment of it

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Tracheoesophageal Fistula

Congenital or acquired connection between the trachea and esophagus

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What are some symptoms of tracheoesophageal fistula?

Aspiration

- Regurgitation shortly after birth

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What diseases are associated with tracheoesophageal fistula?

Congenital heart disease
Neurologic and GU disease
GI malformations

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A 45 year old female with history of travel in South America presents with progressive dysphagia to solids and liquids over the past couple of years. She notes a history of illness caused by a “kissing bug” while traveling but can’t remember the name of the illness. Barium swallow was performed and the following was found. What increased health risk does this woman have moving forward?

A. Sepsis
B. CREST syndrome
C. Streptococcal pharyngitis
D. Squamous cell carcinoma
E. Intracranial hemorrhage

D. Squamous cell carcinoma

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What is achalasia?

Esophageal dysmotility with the LES preventing the passage of food

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What can achalasia be secondary to?

Chagas Disease, Polio, Diabetes, Cancer

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What is an x-ray sign of achalasia?

Bird’s Beak

How can achalasia lead to SCC?

Food trapping will cause chronic irritation leading to metaplasia and eventually SCC

Scleroderma

Autoimmune disorder that affects the connective tissue with CREST syndrome (calcinosis, Raynaud, esophageal dysmotility, sclerodactyly, telangiectasia)

How does scleroderma affect the esophagus?

It leads to the atrophy of the lower 2/3 of the esophagus

Hiatal Hernia

Separation of the diaphragmatic crura and widening of the space which allows for the proximal stomach to move up

What are the symptoms with hiatal hernia?

Sliding and will have reflux symptoms

What are the symptoms with hiatal paraesophageal hernia?

Rolling and will not have reflux symptoms

Mallory-Weiss Tear

Longitudinal tears at the esophageal junction and the gastric cardia with severe retching and only affects the M and SM layers -> NON-life threatening

A 30 year old previously healthy female presents to the emergency room after reporting violent vomiting including episodes of hematemesis. No history of alcoholism or bulimia is obtained from the patient. Physical exam shows subcutaneous emphysema and cardiac auscultation demonstrates crunching, rasping sound, synchronous with the heartbeat, heard over the precordium. Barium study shows the following. The patient is taken to emergent surgery but expires. What is the cause of the patient’s death? ``` A. Rupture of dilated esophageal veins B. Esophageal mucosal laceration(s) C. Esophageal transmural laceration(s) D. Obstruction secondary to tumor E. Gastroesophageal reflux disease ```

C. Esophageal transmural laceration(s)

How can esophageal varices form?

Portal hypertension leads to diversion to the stomach and then to the lower esophagus veins, where it can pool, leading to varices. Often are patients with cirrhosis.

Boerhaave Syndrome

Transmural esophageal tear due to severe vomiting and is an emergency that is life threatening

Reflux Esophagitis

Severe chest pain with redness of the esophagus on endoscopy

What will fungal esophagitis look like?

Pseudomembranes on endoscopy and pseudohyphae on microscopy

What will Herpes simplex virus esophagitis look like?

Punched out ulcers - molding, multinucleation, marginization. Marginization is chromatin in the nucleus pushed to the edge.

What will cytomegalovirus esophagitis look like?

Linear ulcers with large owl eye cells

Eosinophilic Esophagitis

More commonly seen in children and thought to be related to food allergies

Chemical/Pill Induced Esophagitis

Caused by mucosal irritants like alcohol, acids, bases, smoking, medications and uremia

What does edema in esophagitis hint at?

Chemical/Pill Induced Esophagitis

What do eosinophils in esophagitis hint at?

Eosinophilic Esophagitis

A 60 year old obese male present with progressive dysphagia (solids>liquids) and 20 lb weight loss over the last year. He does not drink and has no smoking history. An EGD and biopsy were performed and the following specimen was obtained. What is the most likely cancer type to be present based on the patient history and histology? ``` A. Sarcoma B. Lymphoma C. Squamous cell carcinoma D. Transitional cell carcinoma E. Adenocarcinoma ```

E. Adenocarcinoma

What is the most important risk factor for adenocarcinoma?

Barrett Esophagus

Who does Barrett Esophagus tend to affect?

40-60 yrs and males more than females

What are some symptoms of Barrett esophagus?

Reflux with some possible ulceration and bleeding

What happens to epithelial cells in Barrett esophagus?

Non-ciliated columnar epithelial cells replace normal | cells of the esophagus

What are the diagnostic criteria of Barrett esophagus?

- Salmon or red colored mucosa | - Presence of goblet cells - intestinal metaplasia

What are the common areas for SCC in the esophagus?

Middle to upper third of the esophagus

What can be seen on histology of SCC?

Keratin pearl formation

What is the most common esophageal cancer in Western countries?

Adenocarcinoma

What population is more affected by SCC?

African Americans

What population is more affected by adenocarcinoma?

Caucasians