SM_135b: Pathology of Esophageal Disorders Flashcards
Normal esophagus is lined by ____
Normal esophagus is lined by stratified squamous epithelium
Z-line at junction of stomach and esophagus is the point at which ____
Z-line at junction of stomach and esophagus is the point at which squamous mucosa becomes columnar
Esophagus is lined by ____
Esophagus is lined by stratified squamous epithelium
____ is an inflammatory process due to reflux of gastric or duodenal contents into esophagus secondary to failure of anti-reflux mechanisms
GERD is an inflammatory process due to reflux of gastric or duodenal contents into esophagus secondary to failure of anti-reflux mechanisms
Describe endoscopic findings of reflux esophagitis
Reflux esophagitis endoscopic findings
- Hypereremia or erythema
- Patches resembling leukoplakia
Describe histological findings of reflux esophagitis
Reflux esophagitis histological findings (primarily in distal esophagus)
- Basal cell hyperplasia
- Vascular congestion and extension of vascular papillae to the top half of the overall thickness
- Mixed inflammatory cell infiltrate (eosinophils, lymphocytes, and few neutrophils unless there is erosion / ulceration)
- Ballooning of squamous cells (increased water content)
This is ____ in ____
This is basal cell hyperplasia in reflux esophagitis
This is ____ in ____
This is vascular congestion in reflux esophagitis
This is ____ in ____
This is intraepithelial eosinophils and lymphocytes (squiggles) in reflux esophagitis
These are ____ in ____
These are intraepithelial lymphocytes (squiggles) in reflux esophagitis
These are ____ in ____
These are balloon cells in reflux esophagitis
Complications of reflux esophagitis include ____, ____, and ____
Complications of reflux esophagitis include erosion / ulceration, strictures, and Barrett’s esophagus
- Strictures: from fibrosis secondary to ulceration
____ is loss of superficial epithelium down to muscularis mucosa, while ____ is loss of superficial epithelium above muscularis mucosa
Ulceration is loss of superficial epithelium down to muscularis mucosa, while erosion is loss of superficial epithelium above muscularis mucosa
____ is a chronic immune / antigen-mediated esophageal disease characterized by esophageal dysfunction and eosinophil-predominant inflammation
Eosinophilic esophagitis is a chronic immune / antigen-mediated esophageal disease characterized by esophageal dysfunction and eosinophil-predominant inflammation
Eosinophilic esophagitis is most likely associated with ____, involves the ____ and ____, and is most prevalent in ____
Eosinophilic esophagitis is most likely associated with allergy, involves the proximal and distal esophagus, and is mostprevalent in children/teenagers
Eosinophilic esophagitis endoscopic findings include ____, ____, ____, and ____
Eosinophilic esophagitis endoscopic findings include furrows, rings, strictures, and white patches / plaques
Describe histology of eosinophilic esophagitis
Eosinophilic esophagitis histology
- Prominent intraepithelial eosinophils
- Eosinophilic microabscesses (clusters of multiple eosinophils) often with large clusters near the surface
- Increased intraepithelial lymphocytes
- Basal cell hyperplasia
- Fibrosis in the lamina propria
These are ____ in ____
These are intraepithelial eosinophils in eosinophilic esophagitis
These are ____ and ____ in ____
These are eosinophilic microabscesses and increased intraepithelial lymphocytes in eosinophilic esophagitis
This is ____ in ____
This is lamina propria fibrosis in eosinophilic esophagitis
_____ is conversion of normal squamous epithelium of the esophagus into metaplastic columnar epithelium
Barrett’s esophagus is conversion of normal squamous epithelium of the esophagus into metaplastic columnar epithelium
- Endoscopically recognizable columnar (mucinous) metaplasia of the esophageal mucosa that is confirmed pathologically to contain intestinal metaplasia
Barrett’s esophagus endoscopic findings are ____
Barrett’s esophagus endoscopic findings are salmon pink “gastric type” mucosa in the squamous-lined esophagus
(salmon pink is all proximal to gastroesophageal junction)
Biopsy of Barrett’s esophagus shows ____
Biopsy of Barrett’s esophagus shows some goblet cells in a background of gastric-type mucin cells
Columnar mucinous metaplasia is ____
Columnar mucinous metaplasia is everything with mucin
Intestinal metaplasia is ____
Intestinal metaplasia is goblet cells specifically
Describe pathogenesis of Barrett’s esophagus
Barrett’s esophagus pathogenesis
- Chronic GERD
- Inflammation and ulceration of esophageal sqamous mucosa
- If persistant and recurrent, leads to columnar / mucinous metaplasia which may or may not have intestinal metaplasia (goblet cells)
Development of ____ in Barrett’s esophagus follows a ____ sequence that is characterized by the accumulation of multiple genetic and epigenetic alterations, many of which occur befor ehte onset of morphologic dysplasia
Development of adenocarcinoma in Barrett’s esophagus follows a metaplasia - dysplasia - carcinoma sequence that is characterized by the accumulation of multiple genetic and epigenetic alterations, many of which occur befor ehte onset of morphologic dysplasia
Cancer surveillance in Barrett’s esophagus involves ____ and ____
Cancer surveillance in Barrett’s esophagus involves repeat biopsies b/c incidence of cancer is high and following of patients with biopsies positive for dysplasia
Describe low-grade dysplasia
Low-grade dysplasia
- Epithelial cell nuceli typically elongated, crowded, and hyperchromatic
- Dysplastic cells usually mucin depleted and show a marked decrease in goblet cell differention
This is ____
This is low-grade dysplasia (Barrett’s esophagus)
Describe high-grade dysplasia / carcinoma in situ
High-grade dysplasia / carcinoma in situ
- Overall architecture shows more crypt complexity: cribriforming, variability in size and shape of crypts, and extensive branching
- Cytologically, epithelium shows nuclear stratification, loss of polarity, pleomorphism, enlarged nucleoli, and increased atypical mitotic activity
- As in low-grade dysplasia, mucin depletion and decrease in / abscence of goblet cell and differentiation of high-grade dysplasia
This is ___
This is high-grade dysplasia / carcinoma in situ
Descrine invasive adenocarcinoma
Invasive adenocarcinoma
- Same nuclear features of high-grade dyplasia / carcinoma in situ except invading into tissue
- Almost always distal esophagus and may extend into stomach, arising as a consequence of Barrett’s esophagus
- 15-25% have amplification of oncogene c-ERB-B2 (Her2)
This is ____
This is invasive adenocarcinoma
___ is defined as a malignant epithelial tumor with glandular differentiation, most common in the distal esophagus
Adenocarcinoma is defined as a malignant epithelial tumor with glandular differentiation, most common in the distal esophagus
- Majority of cases arise from the Barrett mucosa
This is a ____ characteristic of ____
This is a polypoid lesion characteristic of adenocarcinoma
____ is the most common esophageal malignancy worldwide but not in the US
Squamous cell carcinoma is the most common esophageal malignancy worldwide but not in the US
- Etiology is multifactorial
Describe pathogenesis of esophageal carcinoma
Esophageal carcinoma pathogenesis
- Normal w/ low/short exposure to carcinogens
- Esophagitis
- Atrophy w/ high/prolonged exposure to carcinogens
- Cancer
Cytologic changes in squamous cell carcinoma include ____, ____, ____, and ____
Cytologic changes in squamous cell carcinoma include nuclear hyperchromasia, pleomorphism, increased nucleus:cytoplas, and increased mitotic rate
This is ____
This is squamous cell carcinoma in situ
This is ____
This is invasive squamous cell carcinoma
Gross pathology of esophageal carcinoma is ____, ____, ____, and ____
Gross pathology of esophageal carcinoma is gross, stenosing, nodular, ulcerated, and lobulated
Squamous cell carcinomas typically invade ____
Squamous cell carcinomas typically invade vertically through the esophageal wall and spread to involve contiguous organs such as the trachea, aorta, and pericardium
(60% of patients have regional lymph node metastases)
