diagnosis of non-neoplastic esophageal lesions the following points
should be kept in mind:
Inflammation throughout esophagus suggests infective cause specially in
The histopathologist must carefully search for organisms and viral
- In suspected case of Cytomegalovirus infection , biopsy should be
taken from the ulcer base to sample infected fibroblasts and endothelial
cells. Microscopic features include large cells in the subepithelial
layer with intranuclear inclusions, a halo around the nucleus and
multiple small cytoplasmic inclusions.
- In Candida
oesophagitis PAS and Grocott stains are useful in demonstrating the
- In Herpes
simplex virus esophagitis biopsy should be taken from the squamous
epithelium at the margins of the ulcer. Microsocpically there are
multinucleated giant cells and intranuclear ground glass inclusions.
2. Acid or
bile reflux is common in the lower third of the esophagus.
is suspected the histopathologist should look for the following
cell hyperplasia ; vascular prominence ; elongation of lamina propria
increased intraepithelial eosinophils and varying degree of chronic
esophagitis may progress to superficial ulceration and spread of
inflammation to the wall.
3. In Barrett's esophagus (columnar lined esophagus) the biopsy may
show any of the following features-
- Fundic type mucosa (with parietal and chief cells)
- Cardiac or junctional type mucosa (composed of mainly mucous
- Flat mucosa with specialised (incomplete) intestinal
Mucin histochemistry is useful in the identification of immature
Presence of submucosal glands with ducts beneath distorted glandular
mucosa is diagnostic of Barrett's esophagus.
In many cases the histopathologists report the case as :
" If the
biopsy is truely from esophagus , it corroborates with an endoscopic
diagnosis of Barrett's esophagus."
dysplasia in Barrett's esophagus is reported as indefinite, low grade or
magnification view is very important.
dysplasia ,due to consistent presence of nuclear hyperchromasia
attention is immediately drawn to the dysplastic area.
To diagnose true dysplasia the full length of the gland must be
assessed. In dysplasia, the cytological changes are present throughout
the crypt from the base to the surface epithelium and there is abrupt
interphase with adjacent epithelium. In reactive hyperplasia there is
surface maturation and gradual transition with adjacent epithelium.
case is reported as: " Indefinite for dyplasia. A repeat biopsy is
advised after the inflammation has subsided."
carcinoma developing in Barrett's esophagus is usually adenocarcinoma in
type. Carcinoma is reported only when there is unequivocal evidence
of invasion into the lamina propria.
An endoscopic biopsy protocol
can differentiate high-grade dysplasia from early adenocarcinoma in
treatment in Barrett's esophagus the biopsy shows squamous re-epithelization.
The histopathologist plays an important role in identifying hidden foci
of glandular mucosa under surface squamous epithelium (deep biopsy is
advised in these cases).
It is often
difficult to make a confident diagnosis: 1) if the esophageal biopsy is
crushed 2) if the biopsy is tangentially cut and 3) in the presence of
inflammation and regenerative changes.