Pathology of Esophagus

Question 1

Common causes of Esophagitis

Answer 1

• 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

Question 2

Histologic characteristics of fungal esophagitis

Answer 2

• 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.

Question 3

Histologic features of viral esophagitis

Answer 3

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

Question 4

Characteristics of reflux esophagitis

Answer 4

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

Question 5

Common causes of reflux esophagitis

Answer 5

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

Question 6

Consequences of untreated reflux esophagitis

Answer 6

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

Question 7

Characteristics/causes of Mallory-Weiss tear

Answer 7

• 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

Question 8

Characteristics of Barrett’s Esophagus

Answer 8

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

Question 9

Macroscopic & Histologic characteristics of Barrett’s esophagus

Answer 9

• 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

Question 10

Low grade vs. high-grade dysplasia in BE

Answer 10

• 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

Question 11

Characteristics + findings of acachlasia

Answer 11

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

Question 12

Major types of esophageal cancer + relative frequency

Answer 12

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

Question 13

Characteristics of adenocarcinoma

Answer 13

• 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

Question 14

Characteristics of squamous cell carcinoma

Answer 14

• 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