Dysplasia in
Barrett Esophagus
Epidemiology and Etiology:
Common sites:
Gross features:
Histologic features:
- indefinite for
dysplasia:
- changes too marked
for normal but not sufficient for dysplasia
- architecture
moderately distorted
- nuclear
abnormalities but less marked than in dysplasia
- other features
that may lead to this diagnosis:
- numerous
dystrophic goblet cells (vacuole is not communicating with the luminal
surface)
- more
extensive nuclear stratification
- diminished
or absent mucous production
- increased
cytoplasmic basophilia
- increased
mitoses
- tangiential
embedding does not allow surface evaluation
- Low-grade dysplasia
- Surface shows no
or only slight maturation
- Architectural abnormalities:
- Budded,
branched, crowded, or irregularly shaped glands
- Papillary
extensions into gland lumina
- Villiform
configuration of the mucosal surface
- Lamina propria
should be identifiable between glands
- Nuclear features:
- Hyperchromatic
- Mild
clumping of chromatin
- Nuclear
membrane irregularities
- Enlargement
is not pronounced
- Stratification
may be present
- Nucleoli
not typically prominent
- Maintainence
of polarity
- Increased
numbers of abnormal mitoses
- Especially
noteworthy if they involve the mucosal surface
- Inflammation typically
minimal
- In the
presence of abundant inflammation with above changes, best to classify
in indefinite category
- High-grade
dysplasia:
- Surface
maturation lacking
- Nuclear
features most important and sufficient for the diagnosis:
- Hyperchromatic
- Irregular
nuclear membranes
- Clumped
chromatin
- Nucleoli
may be prominent/irregular
- Markedly
enlarged
- Loss of
nuclear polarity
- Mitoses
readily identifiable
- Architecture
may be markedly distorted
- Prominent
glandular crowding
- Little
intervening lamina propria
- Inflammation
is typically minimal
- Intramucosal
carcinoma:
- Carcinoma not yet
invaded through the muscularis mucosa
- Effacement of
lamina propria architecture
- Syncytial growth
pattern
- Extensive back to
back microglands
- Intermingling of
single cells and small clusters of cells within the lamina propria
- Desmoplasia typically
absent or incompletely developed
Immunophenotype:
Marker:
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Sensitivity:
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Specificity:
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Molecular features:
Other features:
- progression to
cancer:
- no dysplasia: 0-4%
- indefinite for
dysplasia: 1-18%
- low-grade
dysplasia: 2-18%
- high-grade
dysplasia: 15-60%
References:
- Pathology Case
Reviews (2002) 7(1);39.