Pathology of Esophagus Flashcards Preview

DEMS: Unit 1 > Pathology of Esophagus > Flashcards

Flashcards in Pathology of Esophagus Deck (14):
1

Common causes of Esophagitis

  • Chemical injury
    • –Reflux of gastric contents
    • –Acids, alkalis (e.g. lye), alcohol, tobacco
    • –Medications (e.g. “pill” esophagitis and chemotherapeutics)
  • •Infection
    • –Fungal (e.g. Candida)
    • –Viral (e.g. Herpes simplex virus
  • •Immune related diseases
    • –Eosinophilic esophagitis
    • –Dermatologic diseases (e.g. lichen planus)
  • •Radiation
  • •Trauma
     

2

Histologic characteristics of fungal esophagitis

  • macroscopically: white plaques
  • microscopically: 
    • Pseudohyphae (classic term for candida infection) and budding yeast within tissue
    • Require special stains to visualize: GMS, PAS
    • No change in squamous cells.

3

Histologic features of viral esophagitis

  • common cause = herpes simplex virus
  • macroscopically = punched out ulcers
  • microscopically =
    • Multinucleated cells → several nuclei have come together
    • nuclear moulding
    • intranuclear viral inclusions

4

Characteristics of reflux esophagitis

  •  = injury and inflammation that results from reflux of gastric contents into the esophagus
  • results in the gastroesophageal reflux disease:
    • heartburn
    • dysphagia
    • regurgitation

5

Common causes of reflux esophagitis

  • **transient LES relaxation
  • hiatal hernia
  • decreased LES tone
  • increased intraabdominal pressure
  • delayed gastric emptying

6

Consequences of untreated reflux esophagitis

  • ==> erythema ==> erosion ==> ulceration
  • can lead ==> Barrett's esophagus/metaplasia ==> adenocarcinoma

7

Characteristics/causes of Mallory-Weiss tear

  • Prolonged vomiting → failed relaxation of gastroesophogeal junction (GEJ) musculature → refluxing gastric contents → overwhelm gastric inlet → stretching and tearing of esophageal wall → linear superficial tears near GEJ
  • Clinical note: severe retching or vomiting often secondary to alcohol (i.e. common in alcoholic patients), presents as upper GI bleed

8

Characteristics of Barrett's Esophagus

  • complication of chronic GERD
  • characterized by intestinal glandular metaplasia
  • rising in incidence in the United States
  • confers an increased risk of esophageal cancer

9

Macroscopic & Histologic characteristics of Barrett's esophagus

  • endoscopy: salmon-colored patches
    • biopsy helps grade metaplasia/dysplasia
  • microscopic:
    • squamous epithelium has undergone intestinal metaplasia ==> columnar epithelium
    • gladular epithelium (increased acid mucin cells = light blue color) on alcian blue stain

10

Low grade vs. high-grade dysplasia in BE

  • higher grade has increased likelihood of progression to adenocarcinoma
  • low grade = elongated, dark nuclei w/in columnar cells
  • high-grade = irregular glandular structures
    • rounded nuclei
    • crowded glands

11

Characteristics + findings of acachlasia

  • increased LES tension/pressure + dysmotility of esophagus
  • barium esophagram: megaesophagus + "birds beak" esophagus

12

Major types of esophageal cancer + relative frequency

  • adenocarcinoma
    • increasing incidence due to assoc. w/GERD and obesity
  • squamous cell carcinoma
    • used to be most common, decreased in comparison to adenocarcinoma

13

Characteristics of adenocarcinoma

  • associated w/Barrett's esophagus
  • associated with GERD, tobacco use, and   radiation exposure

  • occurs more commonly in men (7 M : 1 F

  • glandular epithelial malignancy

  • histologic:
    • infiltrative, malignant glands

14

Characteristics of squamous cell carcinoma

  • more common world-wide (Asia and Africa)
  • more common in men (4 M : 1 F) and in   African Americans (8 AA : 1 US Caucasian)
  • associated with alcohol, tobacco, and dietary   factors
  • squamous cell epithelial malignancy
  • histologic:
    • infiltrative nests of squamous cells