Barrett Esophagus

Risk factors: hiatal hernia, duodenogastricreflux ,delayed acid clearance time,

↓LESp Adult disorder → 376 per 100000 Irreversible conditionM/F = 2/1

Specialized columnar epithelium with goblet

cells (positive for Alcian blue in pH:2.5)

Absence of goblet cells is insufficient to make

a definitive diagnosis

“Barrett cytokeratin 7/20 pattern ”

Negative for dysplasia

Indefinite for dysplasia

Low grade dysplasia

High grade dysplasia

Surface maturation (low power)

Architecture (low power)

Cytologic features

Inflammation and erosions/ulcers

Surface epithelium more mature than

underlying glands Normal architecture Nuclear stratification - ↑N/C, small nucleoli,

mitoses are normal in Deeper glands Nuclear polarity and, smooth outlines are

preserved in Deep and superficial

Nuclear membrane irregularity,

hyperchromasia in Deep ,with normal maturation to surface

Active PMN infiltration

No polarity disturbance No architectural abnormality

Extension of cytological abnormalities to

surface (at least focally)

No maturation to surface

Abundant inflammation, prominent nucleoli,

abnormal architectures and loss of polarity

are not LGD features .

Prominent cytologic abnormalities

Markedly distorted glands

Little intervening lamina propria

DNA content (flowcytometry)

P53 → progression