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Esophagus
(Click the section headings (in blue) to expand or collapse the content)
Assessment of Glandular Epithelial Dysplasia
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Diagnostic Category |
Histologic Features |
Clinical Management |
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Reactive atypia / Negative for Dysplasia |
Associated acute inflammation, mild and uniform nuclear changes (i.e. enlargement, chromasia); atypia spares mucosal surface epithelium. |
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Indefinite for Dysplasia * |
Mild nuclear stratification of the surface epithelium or mild nuclear atypia; uniform nuclear atypia; or "low-grade dysplasia" associated with acute inflammation |
Decreased interval between endoscopic surveillance and / or more biopsies |
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Low-grad Dysplasia * |
Atypia involves musocal surface epthelium; atypical glands with crowded, stratified, hyperchromatic nuclei; or nuclear round-up, hyperchromasia, pleomorphism |
Decreased interval between endoscopic surveillance and / or more biopsies |
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High-grade Dysplasia |
Distorted glandular architecture (e.g. crypt branching, villiform mucosal surface, or cribriform pattern). Loss of nuclear polarity, nuclear roud-up and absence of a consistent relationship of nuclei to each other. These changes extend to the mucosal surface. |
Endoscopic mucosal resection or esophogastractomy |
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Intramucosal Adenocarcinoma |
Cytologic atypia as in high-grade dysplasia. Complex glandular architecture, individual malignant cells or abortive glands in the lamina propria; stromal demoplasia may also be present. |
Endoscopic mucosal resection or esophogastractomy |
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*There is significant interobserver and intraobserver variation in the diagnosis of dysplasia in Barrett’s esophagus, particularly at the indefinite/low-grade interface. For this reason the categories of indefinite and low-grade dysplasia may be combined for clinical management purposes.
Assessment of the Differential of Adenocarcinoma
Assessment of the Differential of Squqmous Cell Carcinoma
Graft Versus Host Disease (GVHD), Esophagus
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