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* The [[metaplasia]] of [[Barrett's esophagus]] is visible grossly through a [[gastroscope]], but [[biopsy]] specimens must be [[examined]] under a [[microscope]] to determine whether [[cells]] are [[gastric]] or colonic in [[nature]]. Colonic [[metaplasia]] is usually identified by finding [[goblet cells]] in the [[epithelium]] and is necessary for the final [[diagnosis]] of Barrett's.
* The [[metaplasia]] of [[Barrett's esophagus]] is visible grossly through a [[gastroscope]], but [[biopsy]] specimens must be [[examined]] under a [[microscope]] to determine whether [[cells]] are [[gastric]] or colonic in [[nature]]. Colonic [[metaplasia]] is usually identified by finding [[goblet cells]] in the [[epithelium]] and is necessary for the final [[diagnosis]] of Barrett's.


* [[There]] [[are]] [[many]] [[histologic]]<nowiki/>al [[mimics]] [[of]] [[Barrett's esophagus]] (i.e. [[goblet cells]] [[occurring]] [[in]] [[the]] [[transitional epithelium]] [[of]] [[normal]] [[esophageal]] [[submucosal gland ducts]], [["pseudogoblet cells"]] [[in]] [[which]] [[abundant]] [[foveolar]] [[(gastric)]] [[type]] [[mucin]] [[simulates]] [[the]] [[acid]] [[mucin]] [[true]] [[goblet cells]]).  [[Assessment]] [[of]] [[relationship]] [[to]] [[submucosal glands]] [[and]] [[transitional-type epithelium]] [[with]] [[examination]] [[of]] [[multiple]] [[levels]] [[through]] [[the]] [[tissue]] [[may] [[allow]] [[the]] [[pathologist]] [[to]] [[reliably]] [[distinguish]] [[between]] [[goblet cells]] [[of]] [[submucosal gland ducts]] and [[true]] [[Barrett's esophagus]] (specialized columnar [[metaplasia]]).  [[Use]] [[of]] [[the]] [[histochemical]] [[stain]] [[Alcian]] [[blue]] (with [[pH]]=2.5) [[is]] [[also]] [[frequently]] [[used]] [[to]] [[distinguish]] [[true]] [[intestinal-type]] [[mucins]] [[from]] [[their]] [[histologic]]<nowiki/>al [[mimics]]. [[Recently]], [[immunohistochemical]] [[analysis]] [[with]] [[antibodies]] [[to]] CDX-2 (specific for mid and [[hind-gut]] [[intestinal]] [[derivation]]) [[has]] [[also]] [[been]] [[utilized]] [[to]] [[identify]] [[true]] [[intestinal-type metaplastic cells]].  
* There are [[many]] [[histological]] [[mimics]] of [[Barrett's esophagus]] (i.e. [[goblet cells]] occurring in the [[transitional epithelium]] of [[normal]] [[esophageal]] [[submucosal]] [[gland ducts]], [["pseudogoblet cells"]] [[in]] [[which]] [[abundant]] [[foveolar]] [[(gastric)]] [[type]] [[mucin]] [[simulates]] [[the]] [[acid]] [[mucin]] [[true]] [[goblet cells]]).  [[Assessment]] [[of]] [[relationship]] [[to]] [[submucosal glands]] [[and]] [[transitional-type epithelium]] [[with]] [[examination]] [[of]] [[multiple]] [[levels]] [[through]] [[the]] [[tissue]] [[may] [[allow]] [[the]] [[pathologist]] [[to]] [[reliably]] [[distinguish]] [[between]] [[goblet cells]] [[of]] [[submucosal gland ducts]] and [[true]] [[Barrett's esophagus]] (specialized columnar [[metaplasia]]).  [[Use]] [[of]] [[the]] [[histochemical]] [[stain]] [[Alcian]] [[blue]] (with [[pH]]=2.5) [[is]] [[also]] [[frequently]] [[used]] [[to]] [[distinguish]] [[true]] [[intestinal-type]] [[mucins]] [[from]] [[their]] [[histologic]]<nowiki/>al [[mimics]]. [[Recently]], [[immunohistochemical]] [[analysis]] [[with]] [[antibodies]] [[to]] CDX-2 (specific for mid and [[hind-gut]] [[intestinal]] [[derivation]]) [[has]] [[also]] [[been]] [[utilized]] [[to]] [[identify]] [[true]] [[intestinal-type metaplastic cells]].  


* [[In]] [[the]] [[United States]], [[it]] [[is]] [[estimated]] [[that]] 8 - 12% [[of]] [[patients]] [[who]] [[are]] [[diagnosed]] [[with]] [[Barrett's esophagus]] [[have]] [[been]] [[misdiagnosed]]. [[This]] [[significant]] [[diagnostic]] [[error]] [[may]] [[result]] [[in]] [[higher]] [[rates]] [[of]] [[medical]] [[and]] [[life]] [[insurance]] [[rates]] [[for]] [[those]] [[misdiagnosed]]; [[as well as]] [[enrollment]] [[of]] [[patients]] [[in]] [[unnecessary]] [[surveillance]] [[programs]] (i.e. [[annual]] [[endoscopic]] [[evaluation]] [[and]] [[biopsy]] [[to]] [[monitor]] [[for]] [[the]] [[development] [[of]] [[Barrett's esophagus]]). [[Second]] ([[consulting]]) [[opinions]] [[on]] [[pathologic]] [[materials]] [[are]] [[easily]] [[available]] [[as]] [[slides]] [[and]] [[tissue blocks]] [[are]] [[retained]] [[for] 10 and 20 [[years]], [[respectively]]. [[To]] [[request]] [[a]] [[consultation]] [[opinion]], [[patients]] [[may]] [[contact]] [[their]] [[gastroenterologist]] [[for]] [[referral]] [[to]] [[a]] [[GI]] [[pathology]] [[specialty]] [[center]].
* [[In]] [[the]] [[United States]], [[it]] [[is]] [[estimated]] [[that]] 8 - 12% [[of]] [[patients]] [[who]] [[are]] [[diagnosed]] [[with]] [[Barrett's esophagus]] [[have]] [[been]] [[misdiagnosed]]. [[This]] [[significant]] [[diagnostic]] [[error]] [[may]] [[result]] [[in]] [[higher]] [[rates]] [[of]] [[medical]] [[and]] [[life]] [[insurance]] [[rates]] [[for]] [[those]] [[misdiagnosed]]; [[as well as]] [[enrollment]] [[of]] [[patients]] [[in]] [[unnecessary]] [[surveillance]] [[programs]] (i.e. [[annual]] [[endoscopic]] [[evaluation]] [[and]] [[biopsy]] [[to]] [[monitor]] [[for]] [[the]] [[development] [[of]] [[Barrett's esophagus]]). [[Second]] ([[consulting]]) [[opinions]] [[on]] [[pathologic]] [[materials]] [[are]] [[easily]] [[available]] [[as]] [[slides]] [[and]] [[tissue blocks]] [[are]] [[retained]] [[for] 10 and 20 [[years]], [[respectively]]. [[To]] [[request]] [[a]] [[consultation]] [[opinion]], [[patients]] [[may]] [[contact]] [[their]] [[gastroenterologist]] [[for]] [[referral]] [[to]] [[a]] [[GI]] [[pathology]] [[specialty]] [[center]].

Revision as of 14:06, 22 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amresh Kumar MD [2]

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Microscopic Pathology

  • On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

References

  1. Fléjou J (2005). "Barrett's oesophagus: from metaplasia to dysplasia and cancer". Gut. 54 Suppl 1: i6–12. PMID 15711008.

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