Difference between revisions of "Esophagus"
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==See also== | ==See also== | ||
*[[Stomach]] | *[[Stomach]]. | ||
*[[Gastrointestinal pathology]] | *[[Gastrointestinal pathology]]. | ||
==References== | ==References== | ||
Revision as of 16:33, 17 May 2010
Esophagus connects the pharynx to the stomach. It is afflicted by tumours on occasion. For some reason or another, it seems everyone at SMH gets a esophageal biopsy... yet patients at SB don't have esophagi.
Normal
General:
- Stratified squamous non-keratinized epithelium.
Normal (esophageal) squamous epithelium:
- Should "mature" to the surface like good stratified squamous epithelium does.
- No nuclei at luminal surface.
- Cells should become less hyperchromatic as you go toward the lumen.
- Mitoses should be rare and should NOT be above the basal layer.
- Inflammatory cells should be very rare.
Diagnoses
Common
- Normal.
- Metaplasia (Barrett's esophagus).
- Dysplasia.
- Adenocarcinoma.
Less common
- Squamous cell carcinoma.
- Eosinophilic esophagitis.
- Candidiasis.
- CMV esophagitis.
Indications
- Pyrosis = heartburn.[1]
Infection
Main article: Microorganisms
Is a relatively common problem, especially in those that live at the margins (EtOH abusers) and immunosuppressed individuals (HIV/AIDS).
Useful stains
- PAS.
- Gram stain.
Candidiasis
Micro
- Worm-like micro-organisms.[2]
Image: Esophageal candidiasis - wikipedia.org.
_PAS_stain.jpg){kind=link}
Barrett's esophagus
Definition
- Metaplastic transformation of stratified squamous epithelium to simple columnar epithelium with goblet cells.
Microscopy
- Columnar epithelium.
- Goblets cells -- key feature.
Significance
- Increased risk of adenocarcinoma of the esophagus.
Management
- Long term follow-up/repeat esophagogastroduodenoscopy.
Dysplasia
Classification
- Low grade.
- High grade.
Microscopy
- Nuclear changes.
- Nuclear hyperchromatism.
- Nuclear crowding.
- Cigar-shaped (ellipical) nuclei.
- Nuclear changes present at surface (not only in gland crypts).[3]
- If changes are present at the base but not at the luminal surface -- it "matures" and is not dysplasic.
Notes:
- Changes similar to those see in colorectal tubular adenomas.
- Presence of goblet cells is mildly reassuring its not dysplasia.[4]
Management
Low grade dysplasia.
- Follow-up.
High grade dysplasia.
- Endoscopic mucosal resection.[5]
- Surgical resection ???
Eosinophilic esophagitis
Clinical:
Associations:
Microscopy
Features:[10]
- Mucosa with abundant eosinophils: > 20/HPF.
- Basal cell hyperplasia.
- Papillae elongated.
Treatment
- Avoid exacerbating antigens.
- Topical corticosteroids, e.g. fluticasone.
Cancer
General
- Proximal esophagus: squamous cell carcinoma.
- Distal esophagus: adenocarcinoma arising from Barrett's esophagus.
Risks:
- EtOH.
- Barrett's esophagus.
- Smoking.
Adenocarcinoma of the esophagus
General
- Often a prognosis poor - as diagnosed in a late stage.
- May be difficult to distinguish from adenocarcinoma of the stomach.
Tx
- Adenocarcinoma in situ (AIS) - may be treated with endoscopic mucosal resection & follow-up.[5]
- Surgery - esophagectomy.
IHC
Adenocarcinoma:
- CK7+, CK20+
See also
References
- ↑ http://dictionary.reference.com/browse/pyrosis
- ↑ NEED REF.
- ↑ GAG Jan 2009
- ↑ GAG Jan 2009
- ↑ 5.0 5.1 Sampliner RE (March 2009). "Endoscopic Therapy for Barrett's Esophagus". Clin. Gastroenterol. Hepatol.. doi:10.1016/j.cgh.2009.03.011. PMID 19306943.
- ↑ 6.0 6.1 6.2 PMID 19596009.
- ↑ URL: http://www.medicinenet.com/eosinophilic_esophagitis/page2.htm#tocc. Accessed on: 1 December 2009.
- ↑ GLP P.19.
- ↑ PMID 19841598.
- ↑ GLP P.19.