Pathology of the Esophagus Flashcards
What is a Mallory-Weiss tear?
A Mallory-Weiss tear is a rupture of the lower esophagus at the gastroesophageal junction. It results from prolonged vomiting or wrenching, commonly associated with severe alcoholism, which results in relaxation of the junction and refluxing of gastric contents that overwhelm the gastric inlet. This then leads to stretching and tearing of the esophageal wall which causes upper GI bleeding, a common presentation of the condition.
What does a histology of a Mallory-Weiss tear show, and what condition can result from it?
Histology is significant for nonspecific acute and chronic inflammation. Continued exacerbation of this process can lead to Boerhaave Syndrome, a full thickness esophageal tear with esophageal rupture and mediastinitis.
What are the common causes of esophagitis?
V - I - Herpes, Candida, CMV T - Trauma, Lacerations (Mallory-Weiss), Chemical injury (Corrosive agents, reflux esophagitis) A - Achalasia (Dysmotility) M - I - Systemic disease (Eosinophilic Esophagitis, Chron's disease, Scleroderma) N - C -
What are the characteristic histological features of esophagitis caused by Herpes?
Multinucleated cells, nuclear moulding, Intranuclear viral inclusions, “Punched out” ulcers seen on endoscopy, Patients present with odynophagia, dysphagia, GI bleeding
What are the characteristic histological features of esophagitis caused by Candida?
Pseudohyphae with budding yeast within tissue, Requires special stains to visualize (GMS, PAS), DOES NOT CAUSE ULCERS, only white plaque with fibrinopurulent exudate seen on endoscopy, Patients may present with odynophagia, dysphagia, or are asymptomatic.
What are the characteristic histological features of esophagitis caused by CMV?
Cato- and Nucleo-megaly, Intracytoplasmic Inclusions, “Punched out” ulcers seen on endoscopy usually distal esophagus, Patients present with odynophagia, dysphagia, GI Bleeding, Often occurs in combination with Candida esophagitis.
What is reflux esophagitis?
GERD is characterized by pathologic reflux of stomach acid into the esophagus, mouth, or airways with associated symptoms. This is caused by a weak or defective lower esophageal sphincter, most commonly transient LES relaxation. Other contributing factors include: Delayed gastric emptying, Decreased salivary gland secretions, Increased gastric acid production, hiatus hernia, and Obesity.
What are the symptoms of GERD and why must it be treated?
The symptoms of GERD include: Heartburn, chest pain, asthma, chronic cough, pharyngitis, (NOT JUST Dysphagia). GERD must be treated because 6-12% of GERD patients will develop Barrett’s esophagus, which leads to much higher risk of Adenocarcinoma of the esophagus.
How is Barrett’s esophagus diagnosed?
Barrett’s esophagus is the conversion of the normal squamous epithelium to columnar (intestinal-type) epithelium with goblet cells. It appears as a salmon colored, irregularly shaped patch and is diagnosed via endoscopy and probably pathology.
Why is Barrett’s esophagus examined for dysplasia?
Barrett’s esophagus predisposes the patient to dysplasia and adenocarcinoma. Up to 10% of patients with Barrett’s esophagus will develop adenocarcinoma.
What are the two common types of esophageal carcinoma?
Squamous Cell Carcinoma and Adenocarcinoma
Facts about Adenocarcinoma
95% arise in Barrett’s esophagus, 80% in white males, Incidence rising, Symptoms are dysphagia, odynophagia, obstruction, Commonly found in the distal esophagus with extension into gastric cardia.
Facts about Squamous Cell Carcinoma
DO NOT arise from Barrett’s esophagus, 3-4:1 male:female, Commonly found in mid-esophagus, 20-30% in upper or lower esophagus
What other types of tumors can involve the esophagus?
Benign Esophageal Tumors: Lieomyomas, Hemangiomas, Lymphangiomas
Malignant: Neuroendocrine (carcinoid), Gastrointestinal Stromal Tumors (GIST), Lymphoma, Metastatic (lung, kidney, stomach, breast, melanoma)
