Flashcards in Esophagus Path Deck (30)
What is different about the esophagus than the rest of the gut?
no serosa to help limit spread of tears/rips and cancer
What kinds of muscle is the esophagus made of?
upper - mostly skeletal
middle - skeletal and smooth
distal - mostly smooth
What are the four layers of the wall of the esophagus?
mucosa - squamous epithelial lining and lamina propria, bordered by muscularis mucosa
submucosa - glands
What changes at the gastro-esophageal junction and how is it seen grossly?
squamous lining of esophagus meets glandular of stomach
white/pale tan changes to pink
What are the symptoms of esophageal varices?
none unless they bleed - then light headedness, pale, hematemesis, black tarry stools
Other than esophageal varices, what are other causes of upper GI bleeding?
gastric and duodenal ulcers
less common - gastric tumors, severe GERD, vascular ectasias
What can cause esophagitis?
infections (CMV, Candida)
irritant or corrosive substances
prolonged gastric intubation
XRT or chemo
GERD - most common
What are the symptoms of eosinophilic esophagitis?
dysphagia - most common
recurrent food impactions
maybe hx of atopy
What is the mechanism of eosinophilic esophagitis proposed to be?
corrugated esophagus with concentric mucosal rings found
histamine release from sensitized mast cells - Ach release and contraction of muscularis mucosa
What is seen on endoscopic exam of eosinophilic esophagitis?
circular ridges and longitudinal furrows
dilation of strictures --> tears in mucosa
What are the microscopic features of eosinophilic esophagitis?
top heavy distribution of eosinophils
What are possible symptoms of reflux esophagitis?
odynophagia and dysphagia
erosions and ulcerations of squamous mucosa --> metaplasia = Barrett
nausea after eating
stomach fullness or bloating
What causes GERD?
mechanical problems with LES
slowed gastric clearance
ingestion of irritating substances (smoke, meds)
decreased efficacy of anti-reflux mechanism
What is medical therapy for reflux esophagitis?
surgery to tighten LES
What is the criteria for a pathologist to diagnose reflux esophagitis?
eosinophils, possible neutrophils, in epithelium (not top heavy distribution like EE)
basal zone hyperplasia (>20% of wall)
papillae elongation (more than 2/3 way up epithelium)
What are the potential consequences of severe reflux esophagitis?
fibrosis of esophagus
dysphagia, odynophagia, heartburn and/or slow GI bleeding leading to iron def
What is Barrett esophagus?
replacement of squamous epithelium of distal esophagus with intestinal columnar epithelium, presence of any goblet cells
What does Barrett esophagus put you at risk for?
esophageal adenocarcinoma - esp among men with long term reflux who smoke and drink
What are the two types of esophageal cancer and where in the esophagus do they occur?
squamous cell - upper 2/3
adenocarcinoma - lower 1/3
Which esophageal cancers are increasing and decreasing in prevalence?
SCC decreasing (smoking and alcohol decreasing) - black males
adenocarcinoma increasing (reflux) - white males >50!
What are symptoms of esophageal cancer?
dysphagia, odynophagia, weight loss, chest pain radiating to back, hoarseness, coughing, hematemesis, increased risk of aspiration pneumonia
Why is esophageal cancer often not diagnosed until late stage?
no symptoms til half of lumen is obstructed - already big tumor
What is the microscopic appearance of adenocarcinomas?
arise in glandular epithelium - lumens, cribiforming, papillary growth, mucin production, cohesive cell nests/balls, signet ring forms
Where do SCCs arise?
arise in squamous epithelium - native (skin, esophagus, mouth) or metaplastic (endocervix, bronchi)
What are the microscopic features of SCC?
disordered cell arrangement, hyperchromasia, high N:C ratio, apoptotic figures, keratin, keratin pearls, desmosomes
What is the most important prognostic indicator in esophageal cancer?
What is the basic survival rate for esophageal cancer?
most pts die w/i 1 yr of diagnosis
What are curative treatments for esophageal cancer?
if EARLY - endoscopic mucosal resection, surgical resection, radiation with chemo
What are palliative treatments for esophageal cancer??
stent to keep lumen open, feeding gastrostomy, tumor ablation, radiotherapy