Columnar dysplasia of the esophagus - Revision history

Michael: touch

2015-01-14T06:25:05Z

touch

← Older revision		Revision as of 06:25, 14 January 2015
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	{{ Infobox diagnosis		{{ Infobox diagnosis
	\| Name = {{PAGENAME}}		\| Name = {{PAGENAME}}
	\| Image = High-grade_columnar_dysplasia_of_the_esophagus_-_alt_--_intermed_mag.jpg		\| Image = High-grade_columnar_dysplasia_of_the_esophagus_-_alt_--_intermed_mag.jpg
	\| Width =		\| Width =
	\| Caption = High-grade columnar dysplasia of the esophagus. [[H&E stain]].		\| Caption = High-grade columnar dysplasia of the esophagus. [[H&E stain]].

Michael: /* Low-grade columnar dysplasia */ +images

2014-10-13T05:25:09Z

Low-grade columnar dysplasia: +images

← Older revision		Revision as of 05:25, 13 October 2014
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	*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig6/ Indefinite for columnar dysplasia (nih.gov)].<ref name=pmid17021130/>		*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig6/ Indefinite for columnar dysplasia (nih.gov)].<ref name=pmid17021130/>
	====Low-grade columnar dysplasia====		====Low-grade columnar dysplasia====
			<gallery>
			Image: Low-grade columnar dysplasia of the esophagus -- low mag.jpg \| LGD - low mag. (WC)
			Image: Low-grade columnar dysplasia of the esophagus -- intermed mag.jpg \| LGD - intermed. mag. (WC)
			Image: Low-grade columnar dysplasia of the esophagus -- high mag.jpg \| LGD - high mag. (WC)
			Image: Low-grade columnar dysplasia of the esophagus -- very high mag.jpg \| LGD - very high mag. (WC)
			</gallery>
	www:		www:
	*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F5.html Low-grade columnar dysplasia (nature.com)].<ref name=pmid19581906>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Barrett esophagus: histology and pathology for the clinician. \| journal = Nat Rev Gastroenterol Hepatol \| volume = 6 \| issue = 8 \| pages = 478-90 \| month = Aug \| year = 2009 \| doi = 10.1038/nrgastro.2009.103 \| PMID = 19581906 }}</ref>		*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F5.html Low-grade columnar dysplasia (nature.com)].<ref name=pmid19581906>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Barrett esophagus: histology and pathology for the clinician. \| journal = Nat Rev Gastroenterol Hepatol \| volume = 6 \| issue = 8 \| pages = 478-90 \| month = Aug \| year = 2009 \| doi = 10.1038/nrgastro.2009.103 \| PMID = 19581906 }}</ref>
	*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig2/ Low-grade columnar dysplasia (nih.gov)].<ref name=pmid17021130>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Diagnosis and grading of dysplasia in Barrett's oesophagus. \| journal = J Clin Pathol \| volume = 59 \| issue = 10 \| pages = 1029-38 \| month = Oct \| year = 2006 \| doi = 10.1136/jcp.2005.035337 \| PMID = 17021130 }}</ref>		*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig2/ Low-grade columnar dysplasia (nih.gov)].<ref name=pmid17021130>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Diagnosis and grading of dysplasia in Barrett's oesophagus. \| journal = J Clin Pathol \| volume = 59 \| issue = 10 \| pages = 1029-38 \| month = Oct \| year = 2006 \| doi = 10.1136/jcp.2005.035337 \| PMID = 17021130 }}</ref>

	====High-grade columnar dysplasia====		====High-grade columnar dysplasia====
	<gallery>		<gallery>

Michael at 01:41, 18 June 2014

2014-06-18T01:41:25Z

← Older revision		Revision as of 01:41, 18 June 2014
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	High grade dysplasia:		High grade dysplasia:
	*Endoscopic mucosal resection (EMR).<ref name=pmid19306943>{{cite journal \|author=Sampliner RE \|title=Endoscopic Therapy for Barrett's Esophagus \|journal=Clin. Gastroenterol. Hepatol. \|volume= \|issue= \|pages= \|year=2009 \|month=March \|pmid=19306943 \|doi=10.1016/j.cgh.2009.03.011 \|url=}}</ref>		*[[Endoscopic mucosal resection]] (EMR).<ref name=pmid19306943>{{cite journal \|author=Sampliner RE \|title=Endoscopic Therapy for Barrett's Esophagus \|journal=Clin. Gastroenterol. Hepatol. \|volume= \|issue= \|pages= \|year=2009 \|month=March \|pmid=19306943 \|doi=10.1016/j.cgh.2009.03.011 \|url=}}</ref>
	*Surgical resection (esophagectomy).		*Surgical resection (esophagectomy).

Michael at 01:40, 18 June 2014

2014-06-18T01:40:29Z

← Older revision		Revision as of 01:40, 18 June 2014
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	High grade dysplasia:		High grade dysplasia:
	*Endoscopic mucosal resection.<ref name=pmid19306943>{{cite journal \|author=Sampliner RE \|title=Endoscopic Therapy for Barrett's Esophagus \|journal=Clin. Gastroenterol. Hepatol. \|volume= \|issue= \|pages= \|year=2009 \|month=March \|pmid=19306943 \|doi=10.1016/j.cgh.2009.03.011 \|url=}}</ref>		*Endoscopic mucosal resection (EMR).<ref name=pmid19306943>{{cite journal \|author=Sampliner RE \|title=Endoscopic Therapy for Barrett's Esophagus \|journal=Clin. Gastroenterol. Hepatol. \|volume= \|issue= \|pages= \|year=2009 \|month=March \|pmid=19306943 \|doi=10.1016/j.cgh.2009.03.011 \|url=}}</ref>
	*Surgical resection (esophagectomy).		*Surgical resection (esophagectomy).

Michael: /* Images */

2014-06-18T01:27:03Z

Images

← Older revision		Revision as of 01:27, 18 June 2014
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	No dysplasia - only intestinal metaplasia:		No dysplasia - only intestinal metaplasia:
	*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F4.html Intestinal metaplasia (nature.com)].		*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F4.html Intestinal metaplasia (nature.com)].
	Indefinite for columnar dysplasia:
			====Indefinite for columnar dysplasia====
			www:
	*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F8.html Indefinite for columnar dysplasia (nature.com)].		*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F8.html Indefinite for columnar dysplasia (nature.com)].
	*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig6/ Indefinite for columnar dysplasia (nih.gov)].<ref name=pmid17021130/>		*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig6/ Indefinite for columnar dysplasia (nih.gov)].<ref name=pmid17021130/>
	Low-grade columnar dysplasia:		====Low-grade columnar dysplasia====
			www:
	*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F5.html Low-grade columnar dysplasia (nature.com)].<ref name=pmid19581906>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Barrett esophagus: histology and pathology for the clinician. \| journal = Nat Rev Gastroenterol Hepatol \| volume = 6 \| issue = 8 \| pages = 478-90 \| month = Aug \| year = 2009 \| doi = 10.1038/nrgastro.2009.103 \| PMID = 19581906 }}</ref>		*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F5.html Low-grade columnar dysplasia (nature.com)].<ref name=pmid19581906>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Barrett esophagus: histology and pathology for the clinician. \| journal = Nat Rev Gastroenterol Hepatol \| volume = 6 \| issue = 8 \| pages = 478-90 \| month = Aug \| year = 2009 \| doi = 10.1038/nrgastro.2009.103 \| PMID = 19581906 }}</ref>
	*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig2/ Low-grade columnar dysplasia (nih.gov)].<ref name=pmid17021130>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Diagnosis and grading of dysplasia in Barrett's oesophagus. \| journal = J Clin Pathol \| volume = 59 \| issue = 10 \| pages = 1029-38 \| month = Oct \| year = 2006 \| doi = 10.1136/jcp.2005.035337 \| PMID = 17021130 }}</ref>		*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig2/ Low-grade columnar dysplasia (nih.gov)].<ref name=pmid17021130>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Diagnosis and grading of dysplasia in Barrett's oesophagus. \| journal = J Clin Pathol \| volume = 59 \| issue = 10 \| pages = 1029-38 \| month = Oct \| year = 2006 \| doi = 10.1136/jcp.2005.035337 \| PMID = 17021130 }}</ref>
	High-grade columnar dysplasia:		====High-grade columnar dysplasia====
			<gallery>
			Image: High-grade columnar dysplasia of the esophagus -- low mag.jpg \| HGD - low mag.
			Image: High-grade columnar dysplasia of the esophagus -- intermed mag.jpg \| HGD - intermed. mag.
			Image: High-grade columnar dysplasia of the esophagus - alt -- intermed mag.jpg \| HGD - intermed. mag.
			Image: High-grade columnar dysplasia of the esophagus -- high mag.jpg \| HGD - high mag.
			</gallery>
			www:
	*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F6.html High-grade columnar dysplasia (nature.com)].<ref name=pmid19581906/>		*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F6.html High-grade columnar dysplasia (nature.com)].<ref name=pmid19581906/>
	*[http://www.nature.com/ajg/journal/v104/n10/fig_tab/ajg2009390f3.html High-grade columnar dysplasia (nature.com)].<ref name=pmid19623166>{{Cite journal \| last1 = Riddell \| first1 = RH. \| last2 = Odze \| first2 = RD. \| title = Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead? \| journal = Am J Gastroenterol \| volume = 104 \| issue = 10 \| pages = 2588-94 \| month = Oct \| year = 2009 \| doi = 10.1038/ajg.2009.390 \| PMID = 19623166 }}</ref>		*[http://www.nature.com/ajg/journal/v104/n10/fig_tab/ajg2009390f3.html High-grade columnar dysplasia (nature.com)].<ref name=pmid19623166>{{Cite journal \| last1 = Riddell \| first1 = RH. \| last2 = Odze \| first2 = RD. \| title = Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead? \| journal = Am J Gastroenterol \| volume = 104 \| issue = 10 \| pages = 2588-94 \| month = Oct \| year = 2009 \| doi = 10.1038/ajg.2009.390 \| PMID = 19623166 }}</ref>

Michael at 01:24, 18 June 2014

2014-06-18T01:24:05Z

← Older revision		Revision as of 01:24, 18 June 2014
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	{{ Infobox diagnosis		{{ Infobox diagnosis
	\| Name = {{PAGENAME}}		\| Name = {{PAGENAME}}
	\| Image =		\| Image = High-grade_columnar_dysplasia_of_the_esophagus_-_alt_--_intermed_mag.jpg
	\| Width =		\| Width =
	\| Caption =		\| Caption = High-grade columnar dysplasia of the esophagus. [[H&E stain]].
	\| Synonyms = columnar dysplasia, [[esophageal dysplasia]] (nonspecific term)		\| Synonyms = columnar dysplasia, [[esophageal dysplasia]] (nonspecific term)
	\| Micro =		\| Micro =

Michael at 00:54, 3 April 2014

2014-04-03T00:54:41Z

← Older revision		Revision as of 00:54, 3 April 2014
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	\| Width =		\| Width =
	\| Caption =		\| Caption =
	\| Synonyms = columnar dysplasia, [[esophageal dysplasia]] (nonspecific)		\| Synonyms = columnar dysplasia, [[esophageal dysplasia]] (nonspecific term)
	\| Micro =		\| Micro =
	\| Subtypes = low-grade, high-grade		\| Subtypes = low-grade, high-grade

Michael: +infobox

2014-04-03T00:53:10Z

+infobox

← Older revision		Revision as of 00:53, 3 April 2014
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			{{ Infobox diagnosis
			\| Name = {{PAGENAME}}
			\| Image =
			\| Width =
			\| Caption =
			\| Synonyms = columnar dysplasia, [[esophageal dysplasia]] (nonspecific)
			\| Micro =
			\| Subtypes = low-grade, high-grade
			\| LMDDx = [[intestinal metaplasia of the esophagus]], [[esophageal adenocarcinoma]], [[basal crypt dysplasia]]
			\| Stains =
			\| IHC =
			\| EM =
			\| Molecular =
			\| IF =
			\| Gross =
			\| Grossing =
			\| Site = [[esophagus]] - distal
			\| Assdx = [[Barrett's esophagus]], [[esophageal adenocarcinoma]], [[GERD]]
			\| Syndromes =
			\| Clinicalhx = [[GERD]]
			\| Signs =
			\| Symptoms =
			\| Prevalence = uncommon
			\| Bloodwork =
			\| Rads =
			\| Endoscopy =
			\| Prognosis = pre-malignant (benign)
			\| Other =
			\| ClinDDx =
			\| Tx = low-grade: followup with biopsy; high-grade: resection (surgery, endoscopic mucosal resection)
			}}
	'''Columnar dysplasia of the esophagus''' is a pre-malignant lesion the [[esophagus]] associated with [[Barrett's esophagus]]. It is considered the precursor of [[esophageal adenocarcinoma]].		'''Columnar dysplasia of the esophagus''' is a pre-malignant lesion the [[esophagus]] associated with [[Barrett's esophagus]]. It is considered the precursor of [[esophageal adenocarcinoma]].

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	and '''columnar epithelial dysplasia'''.<ref name=pmid3825997>{{Cite journal \| last1 = Hamilton \| first1 = SR. \| last2 = Smith \| first2 = RR. \| title = The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus. \| journal = Am J Clin Pathol \| volume = 87 \| issue = 3 \| pages = 301-12 \| month = Mar \| year = 1987 \| doi = \| PMID = 3825997 }}</ref>		and '''columnar epithelial dysplasia'''.<ref name=pmid3825997>{{Cite journal \| last1 = Hamilton \| first1 = SR. \| last2 = Smith \| first2 = RR. \| title = The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus. \| journal = Am J Clin Pathol \| volume = 87 \| issue = 3 \| pages = 301-12 \| month = Mar \| year = 1987 \| doi = \| PMID = 3825997 }}</ref>

	===General===		==General==
	*Arises in the setting of ''[[Barrett esophagus]]''.		*Arises in the setting of ''[[Barrett esophagus]]''.
			*Precursor of [[esophageal adenocarcinoma]].

	====Classification====		===Classification===
	#Indefinite for dysplasia.		#Indefinite for dysplasia.
	#*[[Diagnosis]] used in the context of uncertainty (like ''[[gynecologic cytopathology\|ASCUS]]'' and ''[[prostate gland\|ASAP]]''); the classic reason for its use is: the surface (epithelium) cannot be seen (which precludes assessment of maturation); may be used in the context of inflammation.		#*[[Diagnosis]] used in the context of uncertainty (like ''[[gynecologic cytopathology\|ASCUS]]'' and ''[[prostate gland\|ASAP]]''); the classic reason for its use is: the surface (epithelium) cannot be seen (which precludes assessment of maturation); may be used in the context of inflammation.
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	#High grade dysplasia.		#High grade dysplasia.

	====Management====		===Management===
	Low grade dysplasia & indefinite for dysplasia:		Low grade dysplasia & indefinite for dysplasia:
	*Follow-up.		*Follow-up.
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	*Surgical resection (esophagectomy).		*Surgical resection (esophagectomy).

	===Microscopic===		==Microscopic==
	Features to assess:<ref name=Ref_GLP46>{{Ref GLP\|46}}</ref>		Features to assess:<ref name=Ref_GLP46>{{Ref GLP\|46}}</ref>
	# Lack of surface maturation - very common, occasionally absent.<ref name=pmid16625087>{{Cite journal \| last1 = Lomo \| first1 = LC. \| last2 = Blount \| first2 = PL. \| last3 = Sanchez \| first3 = CA. \| last4 = Li \| first4 = X. \| last5 = Galipeau \| first5 = PC. \| last6 = Cowan \| first6 = DS. \| last7 = Ayub \| first7 = K. \| last8 = Rabinovitch \| first8 = PS. \| last9 = Reid \| first9 = BJ. \| title = Crypt dysplasia with surface maturation: a clinical, pathologic, and molecular study of a Barrett's esophagus cohort. \| journal = Am J Surg Pathol \| volume = 30 \| issue = 4 \| pages = 423-35 \| month = Apr \| year = 2006 \| doi = \| PMID = 16625087 }}</ref>		# Lack of surface maturation - very common, occasionally absent.<ref name=pmid16625087>{{Cite journal \| last1 = Lomo \| first1 = LC. \| last2 = Blount \| first2 = PL. \| last3 = Sanchez \| first3 = CA. \| last4 = Li \| first4 = X. \| last5 = Galipeau \| first5 = PC. \| last6 = Cowan \| first6 = DS. \| last7 = Ayub \| first7 = K. \| last8 = Rabinovitch \| first8 = PS. \| last9 = Reid \| first9 = BJ. \| title = Crypt dysplasia with surface maturation: a clinical, pathologic, and molecular study of a Barrett's esophagus cohort. \| journal = Am J Surg Pathol \| volume = 30 \| issue = 4 \| pages = 423-35 \| month = Apr \| year = 2006 \| doi = \| PMID = 16625087 }}</ref>
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	*[[Esophageal adenocarcinoma]].		*[[Esophageal adenocarcinoma]].

	====Images====		===Images===
	No dysplasia - only intestinal metaplasia:		No dysplasia - only intestinal metaplasia:
	*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F4.html Intestinal metaplasia (nature.com)].		*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F4.html Intestinal metaplasia (nature.com)].
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	*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig3/ High-grade columnar dysplasia (nih.gov)].<ref name=pmid17021130/>		*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig3/ High-grade columnar dysplasia (nih.gov)].<ref name=pmid17021130/>

	===Sign out===		==Sign out==
	<pre>		<pre>
	ESOPHAGUS, DISTAL, BIOPSY:		ESOPHAGUS, DISTAL, BIOPSY:
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	- NEGATIVE FOR MALIGNANCY.		- NEGATIVE FOR MALIGNANCY.
	</pre>		</pre>


	==See also==		==See also==

Michael: split out

2014-04-03T00:47:33Z

split out

← Older revision		Revision as of 00:47, 3 April 2014
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	~~#redirect~~ [[~~Esophagus#Columnar_dysplasia_of_the_esophagus~~]]		'''Columnar dysplasia of the esophagus''' is a pre-malignant lesion the [[esophagus]] associated with [[Barrett's esophagus]]. It is considered the precursor of [[esophageal adenocarcinoma]].

			It is also known as '''esophageal columnar dysplasia''' (abbreviated '''ECD'''),<ref name=pmid21809994>{{Cite journal \| last1 = Feng \| first1 = W. \| last2 = Zhou \| first2 = Z. \| last3 = Peters \| first3 = JH. \| last4 = Khoury \| first4 = T. \| last5 = Zhai \| first5 = Q. \| last6 = Wei \| first6 = Q. \| last7 = Truong \| first7 = CD. \| last8 = Song \| first8 = SW. \| last9 = Tan \| first9 = D. \| title = Expression of insulin-like growth factor II mRNA-binding protein 3 in human esophageal adenocarcinoma and its precursor lesions. \| journal = Arch Pathol Lab Med \| volume = 135 \| issue = 8 \| pages = 1024-31 \| month = Aug \| year = 2011 \| doi = 10.5858/2009-0617-OAR2 \| PMID = 21809994 }}</ref>
			'''dysplasia in the columnar-lined esophagus''',<ref>{{Cite journal \| last1 = Levine \| first1 = DS. \| title = Management of dysplasia in the columnar-lined esophagus. \| journal = Gastroenterol Clin North Am \| volume = 26 \| issue = 3 \| pages = 613-34 \| month = Sep \| year = 1997 \| doi = \| PMID = 9309409 }}</ref>
			and '''columnar epithelial dysplasia'''.<ref name=pmid3825997>{{Cite journal \| last1 = Hamilton \| first1 = SR. \| last2 = Smith \| first2 = RR. \| title = The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus. \| journal = Am J Clin Pathol \| volume = 87 \| issue = 3 \| pages = 301-12 \| month = Mar \| year = 1987 \| doi = \| PMID = 3825997 }}</ref>

			===General===
			*Arises in the setting of ''[[Barrett esophagus]]''.

			====Classification====
			#Indefinite for dysplasia.
			#*[[Diagnosis]] used in the context of uncertainty (like ''[[gynecologic cytopathology\|ASCUS]]'' and ''[[prostate gland\|ASAP]]''); the classic reason for its use is: the surface (epithelium) cannot be seen (which precludes assessment of maturation); may be used in the context of inflammation.
			#Low grade dysplasia.
			#High grade dysplasia.

			====Management====
			Low grade dysplasia & indefinite for dysplasia:
			*Follow-up.

			High grade dysplasia:
			*Endoscopic mucosal resection.<ref name=pmid19306943>{{cite journal \|author=Sampliner RE \|title=Endoscopic Therapy for Barrett's Esophagus \|journal=Clin. Gastroenterol. Hepatol. \|volume= \|issue= \|pages= \|year=2009 \|month=March \|pmid=19306943 \|doi=10.1016/j.cgh.2009.03.011 \|url=}}</ref>
			*Surgical resection (esophagectomy).

			===Microscopic===
			Features to assess:<ref name=Ref_GLP46>{{Ref GLP\|46}}</ref>
			# Lack of surface maturation - very common, occasionally absent.<ref name=pmid16625087>{{Cite journal \| last1 = Lomo \| first1 = LC. \| last2 = Blount \| first2 = PL. \| last3 = Sanchez \| first3 = CA. \| last4 = Li \| first4 = X. \| last5 = Galipeau \| first5 = PC. \| last6 = Cowan \| first6 = DS. \| last7 = Ayub \| first7 = K. \| last8 = Rabinovitch \| first8 = PS. \| last9 = Reid \| first9 = BJ. \| title = Crypt dysplasia with surface maturation: a clinical, pathologic, and molecular study of a Barrett's esophagus cohort. \| journal = Am J Surg Pathol \| volume = 30 \| issue = 4 \| pages = 423-35 \| month = Apr \| year = 2006 \| doi = \| PMID = 16625087 }}</ref>
			#*Lack of lighter staining at surface.
			#*Nuclear crowding at surface.
			#*Nuclei at the surface not smaller.
			# Architecture - esp. at low power.
			#* Glands not round.
			#** Low-grade feature: gland budding.
			#** High-grade features: cribriforming, cystic dilation, necrotic debris.
			#* Gland density:
			#** Increased & round - think low-grade dysplasia.
			#** Increased & irregular - think high-grade dysplasia.
			# Cytology, esp. at high magnification.
			#* Nuclear abnormalities in: size, staining, shape.
			#* Loss of "nuclear polarity" = high-grade feature
			#** Loss of palisaded appearance, rounding-up of nuclei.
			# Inflammation, erosions & ulceration.
			#* Marked inflammation should prompt consideration of knocking down the diagnosis one step, i.e. low-grade becomes indefinite ''or'' high-grade becomes low-grade.

			Negatives:
			#No desmoplasia.
			#*Stromal fibrotic reaction to the tumour.
			#**Desmoplasia is rare in the superficial esophagus.<ref name=Ref_GLP49>{{Ref GLP\|49}}</ref>
			#No single cells.
			#No extensive back-to-back glands.

			Notes:
			*Changes similar to those see in colorectal tubular adenomas; however, what would be low-grade dysplasia in the rectum is high-grade dysplasia in the esophagus.
			*Presence of goblet cells suggests it is not dysplasia.<ref>GAG. January 2009.</ref>
			*Desmoplasia present = invasive adenocarcinoma.<ref name=Ref_GLP54>{{Ref GLP\|54}}</ref>
			*Some literature suggests community pathologists should ''not'' make this call, i.e. it should be diagnosed by an expert.<ref name=pmid10385717>{{Cite journal \| last1 = Alikhan \| first1 = M. \| last2 = Rex \| first2 = D. \| last3 = Khan \| first3 = A. \| last4 = Rahmani \| first4 = E. \| last5 = Cummings \| first5 = O. \| last6 = Ulbright \| first6 = TM. \| title = Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice. \| journal = Gastrointest Endosc \| volume = 50 \| issue = 1 \| pages = 23-6 \| month = Jul \| year = 1999 \| doi = \| PMID = 10385717 }}</ref>

			DDx:
			*[[Intestinal metaplasia of the esophagus]].
			*[[Esophageal adenocarcinoma]].

			====Images====
			No dysplasia - only intestinal metaplasia:
			*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F4.html Intestinal metaplasia (nature.com)].
			Indefinite for columnar dysplasia:
			*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F8.html Indefinite for columnar dysplasia (nature.com)].
			*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig6/ Indefinite for columnar dysplasia (nih.gov)].<ref name=pmid17021130/>
			Low-grade columnar dysplasia:
			*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F5.html Low-grade columnar dysplasia (nature.com)].<ref name=pmid19581906>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Barrett esophagus: histology and pathology for the clinician. \| journal = Nat Rev Gastroenterol Hepatol \| volume = 6 \| issue = 8 \| pages = 478-90 \| month = Aug \| year = 2009 \| doi = 10.1038/nrgastro.2009.103 \| PMID = 19581906 }}</ref>
			*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig2/ Low-grade columnar dysplasia (nih.gov)].<ref name=pmid17021130>{{Cite journal \| last1 = Odze \| first1 = RD. \| title = Diagnosis and grading of dysplasia in Barrett's oesophagus. \| journal = J Clin Pathol \| volume = 59 \| issue = 10 \| pages = 1029-38 \| month = Oct \| year = 2006 \| doi = 10.1136/jcp.2005.035337 \| PMID = 17021130 }}</ref>
			High-grade columnar dysplasia:
			*[http://www.nature.com/nrgastro/journal/v6/n8/fig_tab/nrgastro.2009.103_F6.html High-grade columnar dysplasia (nature.com)].<ref name=pmid19581906/>
			*[http://www.nature.com/ajg/journal/v104/n10/fig_tab/ajg2009390f3.html High-grade columnar dysplasia (nature.com)].<ref name=pmid19623166>{{Cite journal \| last1 = Riddell \| first1 = RH. \| last2 = Odze \| first2 = RD. \| title = Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead? \| journal = Am J Gastroenterol \| volume = 104 \| issue = 10 \| pages = 2588-94 \| month = Oct \| year = 2009 \| doi = 10.1038/ajg.2009.390 \| PMID = 19623166 }}</ref>
			*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/figure/fig3/ High-grade columnar dysplasia (nih.gov)].<ref name=pmid17021130/>

			===Sign out===
			<pre>
			ESOPHAGUS, DISTAL, BIOPSY:
			- LOW-GRADE COLUMNAR EPITHELIAL DYSPLASIA, SEE COMMENT.
			- COLUMNAR EPITHELIUM WITH GOBLET CELL METAPLASIA.
			- REACTIVE SQUAMOUS EPITHELIUM.

			COMMENT:
			This was reviewed with Dr. X and they agree with the diagnosis.
			</pre>

			====Alternate====
			<pre>
			ESOPHAGUS, 30 CM, BIOPSY:
			- LOW-GRADE COLUMNAR DYSPLASIA WITH INTESTINAL METAPLASIA AND MILD CHRONIC
			INFLAMMATION.
			- NEGATIVE FOR MALIGNANCY.
			</pre>


			==See also==
			*[[Esophagus]].
			*[[Esophageal adenocarcinoma]].

			==References==
			{{Reflist\|2}}

			[[Category:Esophagus]]
	[[Category:Diagnosis]]		[[Category:Diagnosis]]

Michael: redirect

2012-10-09T17:06:22Z

redirect

New page

#redirect [[Esophagus#Columnar_dysplasia_of_the_esophagus]]

[[Category:Diagnosis]]