Barrett Esophagus

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Barrett Esophagus. General concept. Risk factors: hiatal hernia, duodenogastric reflux ,delayed acid clearance time, ↓LESp Adult disorder → 376 per 100000 Irreversible condition M/F = 2/1. Definition. Specialized columnar epithelium with goblet cells (positive for Alcian blue in pH:2.5) - PowerPoint PPT Presentation

Transcript of Barrett Esophagus

  • Risk factors: hiatal hernia, duodenogastricreflux ,delayed acid clearance time, LESp Adult disorder 376 per 100000 Irreversible conditionM/F = 2/1

  • Specialized columnar epithelium with goblet cells (positive for Alcian blue in pH:2.5) Absence of goblet cells is insufficient to make a definitive diagnosis Barrett cytokeratin 7/20 pattern

  • Negative for dysplasia Indefinite for dysplasiaLow grade dysplasiaHigh grade dysplasia

  • Surface maturation (low power)Architecture (low power) Cytologic features Inflammation and erosions/ulcers

  • Surface epithelium more mature than underlying glands Normal architecture Nuclear stratification - N/C, small nucleoli, mitoses are normal in Deeper glands Nuclear polarity and, smooth outlines are preserved in Deep and superficial

  • Nuclear membrane irregularity, hyperchromasia in Deep, with normal maturation to surface Active PMN infiltrationNo polarity disturbance No architectural abnormality

  • Extension of cytological abnormalities to surface (at least focally)No maturation to surface Abundant inflammation, prominent nucleoli, abnormal architectures and loss of polarity are not LGD features.

  • Prominent cytologic abnormalities Markedly distorted glands Little intervening lamina propria

  • DNA content (flowcytometry) P53 progression