Esophagus Flashcards
(19 cards)
Layers
Mucosa (inner) –> submucosa –> musclaris propria –> serosa/adventitia
These are important in cancer staging
Cell types of esophagus
Lined by SQUAMOUS MUCOSA (flat epithelium)
Stomach, SI, Colon –> SIMPLE COLUMNAR (elongated, basal nuclei)
3 most common causes of infectious esophagitis?
HERPES
CMV
CANDIDIASIS
More common in immunocompromised
Herpes Esophagitis
Multiple shallow ulcerations on the DISTAL esophagus
Histo –> cellular debris, neutrophils, GIANT CELLS, ground glass nuclei, necrosis
GIANT CELLS usually enough to indicate herpes esophagitis
CMV Esophagitis
Distinguished by a SINGLE, DEEP ULCER
Intranuclear or Intracytoplasmic inclusions in large endothelial and fibroblas cells; some cells may have one or two nuclei
Fungal Esophagitis
White-yellow plaques with mucosal ulceration
Histo –> necrotic inflammation with neutrophils and NO MULTINUCLEATED GIANT CELLS and NO INTRANUCLEAR INCLUSIONS
See fungal pseudohyphae/budding yeasts on silver stain
Reflux Esophagitis
Presents with DYSPHAGIA, HEARTBURN
Due to BACKFLOW/REFLUX of the gastric contents into the LOWER ESOPHAGUS
Happens most in hiatal hernias, but also with alcoholism, scleroderma, recurrent vomiting
MOST FREQUENT CAUSE OF ESOPHAGITIS
Associated with GERD
Basal Cell Hyperplasia + Eosinophils + Lymphocytes = REFLUX ESOPHAGITIS
Can develop into Barrett Esophagus
Eosinophilic Esophagitis
Presents like GERD
HALLMARK is that there is a LARGE # OF INTRAEPITHELIAL SUPERFICIAL EOSINOPHILS
Difference from GERD is that there will be plenty of eosinophils both PROXIMALLY and DISTALLY
In GERD, ONLY Distal inflammation
Barrett’s Esophagus
Complication from CHRONIC GERD characterized by INTESTINAL METAPLASIA WITHIN THE ESOPHAGEAL SQUAMOUS MUCOSA
This is a Pre-Malignant Condition
10% of people with chronic GERD/reflux esophagitis get it –> 0.2-2% of Barrett’s patients get DYSPLASIA –> 10% of these patients develop adenocarcinoma
Progression of Barrett’s
REFLUX esophagitis –> Barrett’s –> Barrett’s with low grade dysplasia –> Barrett’s with high grade dysplasia –> Adenocarcinoma
Diagnosing Barrett’s
Endoscopic evaluation shows abnormal mucosa ABOVE the Gastro-esophageal junction (intestinal metaplasia of the stomach is NOT indicative)
Histology shows intestinal metaplasia (goblet cells)
Gross and Histo of Barrett’s
Gross –> Normally, there is a clear divide between the stomach and esophagus
In Barrett’s, the delineation is LOST, and the esophagus goes from white-pink to DEEP RED in color
Histo –> Transition from SQUAMOUS to COLUMNAR MUCOSA –> many large, vacuolated cells with basal nuclei (GOBLET CELLS with MUCIN)
Treating BE
If high grade dysplasia is present (larger, pleomorphic cells) and the patient is young enough (40-50) –> ESOPHAGECTOMY because of the high association with invasive adenocarcinoma
Older patients –> Endoscopic mucosal resection to preserve the muscle layer
Most common esophageal neoplasm?
SQUAMOUS CELL CARCINOMAS
But adenocarcinomas are on the rise
Squamous Papillomas
Most common BENIGN epithelial tumor of the esophagus
Prevalence = 1%
HIGH ASSOCIATION WITH HPV
Gross – exophytic broad based, elevated polyploid nodule
Histo – EXOPHYTIC type, ENDOPHYTIC type, SPIKE type
All show PAPILLOMATOSIS and KOILOCYTOSIS (active viral infection)
Leiomyoma
Most common MESENCHYMAL tumor of the esophagus
8% prevalence
Gross - round tumor with CLEAR boundaries
Histo - SPINDLE cells with eosinophilic cytoplasm and NO nuclear atypia
Esophageal ADENOCARCINOMA
Arise after chronic GERD develops into BARRETT’S with high grade dysplasia
Found in WHITES, M > F
Associated with chromosomal abnormalities and the p53 gene
Gross – POLYPLOID, ULCERATED TUMOR at the Gastroesophageal JUNCTION
Histology –> GLANDS, mucinous, Signet Ring Cells, Nests of cells
5 year survival is 80% if stage T1
Drops dramatically if advanced, and that is unfortunately more common
Squamous Cell Carcinoma
Can occur in the MIDDLE THIRD of the esophagus (as opposed to just at the GE like adeno)
Begin as in situ lesions termed SQUAMOUS DYSPLASIA
Associated with achalasia (lack of peristalsis in esophagus), chronic esophagitis, strictures, alcohol, tobacco
Blacks 4x more than whites, M > F
Gross - large ulcer in the MIDDLE of the esophagus!
Histo - Differentiated squamous cells; eosinophilic ctyoplasm, great boundaries between cells –> “bridging”
Markers for Adeno vs. SCC
Adeno = MUCIN +
SCC = P53+, CK5/6+
