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Possible pathogenesis of achalasia cardia
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CXR shows achalasia
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Dilated esophagus
Contributed by Avani Pendse, M.D., Ph.D.
Endoscopic ultrasound
Contributed by Avani Pendse, M.D., Ph.D.
Upper endoscopy
Contributed by Avani Pendse, M.D.
Distal esophagus and GE junction tumor
Ulcer at GE junction
Treated tumor
Contributed by Avani Pendse, M.D., Ph.D.
Tubular pattern
Papillary pattern
Mucinous pattern
Signet ring cell pattern
Barrett esophagus
Low grade dysplasia
High grade dysplasia
PDL1 positivity
Contributed by Avani Pendse, M.D., Ph.D.
Hypercellular smear
Malignant cells on Diff-Quik
Malignant cells on Pap
Contributed by Dr. Mark R. Wick and @RaulSGonzalezMD on Twitter
https://bit.ly/3zqGbca #pathology #gipath #PathTwitter #PathOutPic"Contributed by @RaulSGonzalezMD on Twitter (see original post here)">
Adenoid cystic carcinoma
Contributed by @RaulSGonzalezMD on Twitter (see original post here)">
https://bit.ly/3zqGbca #pathology #gipath #PathTwitter #PathOutPic"Contributed by @RaulSGonzalezMD on Twitter (see original post here)">
Adenoid cystic carcinoma
AFIP images
Mucosa and submucosa
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4 weeks - relation of gut to yolk sac
Diaphragmatic crura
Arterial blood supply
Venous drainage
Nerves
Lymphatic drainage
Cervical region
AFIP images
Z line - endoscopic appearance
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Gastroesophageal junction
Upper left: small intestine
bottom left: esophagus
center: stomach
top right: pancreas; right: liver
Top: spine
lower left: trachea amd esophagus
center: lung, glandular stage
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BE biopsy protocol
BE Prague classification
Prague criteria
AFIP images
Normal and BE
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Salmon colored mucosa
Endoscopy: mucosal erythema of lower esophagus
Contributed by Dipti M. Karamchandani, M.D.
BE
Goblet cells
Pseudogoblet cells
Four lines
Hybrid glands
Squamous overgrowth
Baseline atypia
Muscularis mucosae duplication
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Nodule on endoscopy
Endoscopic mucosal resection
Narrow band imaging
Endoscopic treatment of Barrett high grade dysplasia
Wide area transepithelial sampling
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High grade dysplasia
Contributed by Dipti M. Karamchandani, M.D.
Indefinite for dysplasia
Indefinite for dysplasia with surface erosion
Low grade dysplasia
Low grade dysplasia higher power
Low grade dysplasia demarcation
High grade dysplasia
High grade dysplasia higher power
High grade dysplasia intraluminal necrotic debris
Gastric foveolar type dysplasia
Gastric foveolar type dysplasia, higher power
Update on recently developed quality metrics
Contributed by Jinping Lai, M.D., Ph.D.
CT scan
PET / CT
Contributed by Jinping Lai, M.D., Ph.D.
Subepithelial mass
Fungating masses
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Mid esophageal mass gross examination
Contributed by Jinping Lai, M.D., Ph.D. and AFIP images
Nested arrangements
Tumor cells touch the epithelium
Small blue tumor cells
Mitosis and apoptosis
p16
p40
p63
p53
CDX2
Synaptophysin
Chromogranin
CK7
Small dark tumor cells
Peripheral basal type cells
Focus of squamous differentiation
Strands of tumor cells touch epithelium
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Longitudinally oriented plaque-like lesions
Contributed by Divya Salibindla, M.D.
Yellow-white mucosal plaques
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Focal erosion
Tan-yellow
plaques with
mucosal erythema
Contributed by Divya Sharma, M.D., Andrey Bychkov, M.D., Ph.D. and Jijgee Munkhdelger, M.D., Ph.D.
Ulcerative esophagitis
Prominent acute inflammatory infiltrate
Esophageal biopsy
Acute inflammation
Pseudohyphae within the epithelium
Candida inflammatory exudate
Yeast forms and pseudohyphae
Fungi on GMS
GMS positive fungi
GMS stain
Contributed by Divya Salibindla, M.D.
Esophageal brushing
Candida esophagitis
Contributed by Kathryn A. Peterson, M.D., M.Sci.
Ulcerated esophageal mucosa
Contributed by Gillian L. Hale, M.D., M.P.H.
Inflammation and CMV inclusions
Numerous viropathic inclusions
Infected endothelial cells
Granular inclusions
CMV IHC
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Spheroid virions
Contributed by Yoko Tateishi, M.D., Ph.D.
Esophageal ulcers
Contributed by Yoko Tateishi, M.D., Ph.D.
Epithelioid granuloma(s)
Increased intraepithelial lymphocytosis
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Epiphrenic diverticula
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Epiphrenic diverticulum
Contributed by Pankaj Vohra, M.D.
Furrows
Tear
Contributed by Ryan C. Braunberger, M.D. and Joshua A. Hanson, M.D.
Extreme basal cell hyperplasia
Surface concentration of eosinophils
Eosinophilic microabscess
Eosinophil degranulation
Endoscopic features of eosinophilic esophagitis
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Scaly white plaque
Contributed by Yukihiro Nakanishi, M.D., Ph.D.
Orthokeratosis /
hyperorthokeratosis
Prominent granular layer
Contributed by Elliot Weisenberg, M.D.
Adenocarcinoma
Squamous cell carcinoma
Contributed by Elliot Weisenberg, M.D.
Adenocarcinoma
Adenocarcinoma in lymphatics
Squamous cell carcinoma in situ
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Distal and proximal oesophagus
Severe atrophy of circular muscle
Myenteric plexus
Interstitial cells of Cajal
Barrett esophagus
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Collagen between
degenerate muscle
fiber (left) and necrotic
muscle fiber (right)
Muscle fibers (M)
separated by collagenous
fibers with widened
intermyofibrillar space
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Dilated thoracic esophagus
Gastrographin esophagography
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GIST
Leiomyosarcoma
Liposarcoma
AFIP images
Sarcoma
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GIST
Liposarcoma
Contributed by AFIP and Dr. Zafar Ali
Sarcoma, not otherwise specified
36 year old man with mass just below upper esophageal sphincter, synovial sarcoma (biphasic)
CD99
EMA
TLE1
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Leiomyosarcoma
Liposarcoma
Osteosarcoma
Contributed by Divya Sharma, M.D.
Tissue paper esophagus
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Vertical white sloughing mucosal strips
Sloughing of large
esophageal mucosa
fragments
Endoscopy showing EDS
Vertical fissures in
distal esophagus with
sloughing of mucosa
Contributed by Divya Sharma, M.D. and @Rasamh86 on Twitter
2 tone esophagus
Prominent parakeratosis
Intraepithelial splitting
Dense parakeratosis
Intraepithelial cystic degeneration
Inflammatory infiltrate
Esophagitis dissecans superficialis
Sloughing esophagitis
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Sloughing of large
esophageal mucosa
fragments
Endoscopy showing EDS
Vertical fissures in
distal esophagus with
sloughing of mucosa
Contributed by Israh Akhtar, M.D.
Intramural mass
Fascicles of spindle cells
Spindle cells
Nuclear details
Mast cells
KIT
DOG1
CD34
Desmin
Ki67
Posttherapy
Epithelioid GIST
Mitosis
High grade GIST
KIT
Contributed by Israh Akhtar, M.D.
High cellularity
Spindle cells
Fascicular pattern
Spindle cells
Epithelioid GIST
Epithelioid cells
Cell block
DOG1
High grade GIST
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Cytoplasmic vesicles in high risk GIST
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Sausage shaped mass
Contributed by Yukihiro Nakanishi, M.D., Ph.D.
Fibroadipose tissue with slightly enlarged, hyperchromatic stromal cells
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Discrete, rounded nodules and plaques
AFIP images
Numerous white islands
Slightly elevated longitudinal plaque
Contributed by Aaron R. Huber, D.O. and @RaulSGonzalezMD on Twitter
Esophageal squamous mucosa with abundant intracytoplasmic glycogen
Clear cytoplasm of squamous epithelial cells
Intracytoplasmic glycogen highlighted with PAS
Intracytoplasmic glycogen that is diastase sensitive
Glycogenic acanthosis
Glycogenic acanthosis
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With lymphocytic infiltrate
Contributed by Dr. Oleksandr Grygoruk, AFIP and @RaulSGonzalezMD on Twitter
Abrikossoff esophagus
Tumor fills lamina propria
Contributed by @RaulSGonzalezMD on Twitter (see original post here)">
shorturl.at/cdglN #pathology #gipath #PathTwitter #PathOutPic"Contributed by @RaulSGonzalezMD on Twitter (see original post here)">
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Granular cell tumor
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Sections to obtain from esophagectomy specimen
How to obtain sections from margins
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Esophagectomy with proximal portion of stomach
Esophagectomy specimen status posttreatment
Esophageal endoscopic mucosal resection
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Endoscopic images
Contributed by Yukihiro Nakanishi M.D., Ph.D. and @MirunaPopescu13 on Twitter
Intermediate power
Heterotopic / ectopic sebaceous glands
Contributed by Yoko Tateishi, M.D., Ph.D.
Red patches
Multiple patches
Contributed by Yoko Tateishi, M.D., Ph.D.
Red patch
Contributed by Yoko Tateishi, M.D., Ph.D.
Isolated gastric mucosa
Oxyntic / fundic type gastric mucosa
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Esophageal layering schematic
GI layering
Esophageal sphincters
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Micro CT of human esophagus
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Human cadaveric esophagus
Contributed by Nicole Stringham, Ph.D. (sources: University of Michigan virtual slide box and Duke University virtual slide collection) and AFIP
GI layering, middle third
Epithelium and lamina propria
Mucosal lymph nodule, submucosal gland
Muscularis externa
Myenteric plexus
Lower third
Smooth and skeletal muscle
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Brushing specimen of normal esophagus
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TEM of epithelial Langerhans cells
SEM of muscularis mucosae
Normal esophagus histology
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Endoscopic features
Diffuse mucosal erosions and ulcerations
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Punched out ulcers
Contributed by James Mueller, M.D., Ph.D.
Esophageal biopsy
Prominent acute inflammation
Cowdry A inclusion
3 Ms
Multinucleation
Glassy chromatin
Edge of the ulcer
Viral cytopathic effect
HSV IHC stain
Overview of HSV esophagitis
Gross and histopathologic findings of HSV esophagitis
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Endoscopic examination
AFIP images
Bulging, white, whorled cut surface
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Submucosal tumor
With squamous cell carcinoma
AFIP images
Cluster of seedling leiomyomas
Seedling leiomyoma of muscularis propria
Leiomyoma with overlying squamous epithelium
Mature, hypertrophied smooth muscle cells
Multiple seedling leiomyomas
Leiomyoma of muscularis propria
Fascicular growth pattern
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Squamous cell carcinoma and leiomyoma
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Groups of spindled cells with low cellularity
Contributed by David Matthew Saulino, D.O. and David Hernandez Gonzalo, M.D.
Grade D esophagitis: mucosal
breaks involving at least 75%
of the esophageal circumference
Contributed by David Matthew Saulino, D.O. and David Hernandez Gonzalo, M.D.
Lymphocytes and dyskeratosis
Civatte bodies
Contributed by Omar Aljuboori, M.B.B.S.
Diffuse changes
Contributed by Monica T. Garcia-Buitrago, M.D., Omar Aljuboori, M.B.B.S. and @RaulSGonzalezMD on Twitter
Intraepithelial lymphocytosis
Damaged esophageal epithelium
Lymphocytic esophagitis
Lymphocytic esophagitis
CD3 stain
CD4 stain
CD8 stain
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Strictures:
Marked 3 cm narrowing
Irregular outline and multiple filling defects
Luminal narrowing
Esophageal thickening ± mass lesions:
4 x 4 cm esophageal mass
Thickening of the esophageal wall
Thickening the aortic arch to the gastrointestinal junction
Endoscopic ultrasound:
Transmural thickening of the esophageal wall
Hypoechoic thickening
Primary esophageal Hodgkin lymphoma:
Submucosal nodules
Circumferential thickening
Aneurysmal dilatation
Nodular thickening of esophageal wall
Fistula to lobectomy
Images hosted on other servers:
Endoscopy:
Multiple solid, firm nodular lesions
Ulcerated tumor
Large, rounded mass
Solid, firm nodular lesions
Multiple lymphomatous polyposis
Images hosted on other servers:
Ulcerated burgeoning masses
MALT: esophagus /
proximal stomach
are unremarkable
Images hosted on other servers:
Diffuse large B cell lymphoma
Mantle cell lymphoma
Mantle cell lymphoma
Mycosis fungoides
MALT lymphoma:
Dense submucosal lymphocytic infiltrate
Vaguely nodular growth pattern
Monocytoid appearance
Germinal centers
CD20+
CD20+
BCL6+ in germinal centers
BCL6+
CD10
Ki67
Kappa / lambda
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DLBCL
Burkitt lymphoma
MALT lymphoma
Contributed by Yukihiro Nakanishi, M.D., Ph.D.
Elevated lesion
Contributed by Yukihiro Nakanishi, M.D., Ph.D.
Protruding mass
Contributed by Yukihiro Nakanishi, M.D., Ph.D.
Protruding mass
Contributed by Yukihiro Nakanishi, M.D., Ph.D. and @RaulSGonzalezMD on Twitter
Protruding mass
Prominent nucleoli
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Endoscopic findings
AFIP images
Bulky, ulcerated, infiltrative lesion
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Small cell
carcinoma (upper),
squamous cell
carcinoma (lower)
Contributed by Gillian L. Hale, M.D., M.P.H., Mark R. Wick, M.D. and AFIP
Sheets of tumor cells with central necrosis
Large cells with
prominent nucleoli
and numerous
mitoses
Diffusely infiltrating sheets of small cells
In muscularis
In situ component
Squamous cell differentiation
Pancytokeratin immunostain
Synaptophysin immunostain
Chromogranin immunostain
Contributed by Yale Rosen, M.D.
Small cell carcinoma
Images hosted on other servers:
Neurosecretory granules
AFIP images
Bulky, ulcerated, infiltrative lesion
Images hosted on other servers:
Small cell
carcinoma (upper),
squamous cell
carcinoma (lower)
Contributed by Mark R. Wick, M.D. and AFIP images
Small cell carcinoma of esophagus
In muscularis
Small cell neuroendocrine carcinoma:
Diffusely infiltrating sheets of small cells
In situ component
Squamous cell differentiation
Contributed by Mark R. Wick, M.D.
Neuroendocrine tumor
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Carcinoid tumor
Small cell carcinoma
Images hosted on other servers:
Neurosecretory granules
Contributed by Ankur Sangoi, M.D.
Kayexalate damage:
Various images
AFB stain
AFIP images
Esophageal squamous cell carcinoma
Radiation has destroyed tumor
Deep ulcer with necrotic base
AFIP images
Normally oriented
epithelium is
thinner than
normal
Radiated esophageal squamous cell carcinoma
Irradiated squamous carcinoma
Images hosted on other servers:
Neovascularization (highlighted with CD31)
Contributed by Aaron R. Huber, D.O.
Squamous mucosa
Gastroesophageal junction
Images hosted on other servers:
Netter drawings of A and B rings
Images hosted on other servers:
Endoscopy images:
With distal hiatal hernia
Meat (chicken) impaction
Mulitple rings
Schatzki ring
Contributed by Dr. Mark R. Wick
Rhabdomyosarcomatous differentiation
Contributed by Dr. Mark R. Wick
With rhabdomyosarcomatous differentiation
AFIP images
Pseudosarcomatous squamous cell carcinoma
Images hosted on other servers:
8th edition TNM categories
Contributed by Xiaoqin Liu, M.D., Ph.D. and Aaron R. Huber, D.O.
Obstructing lesion of esophagus
Eccentric esophageal wall thickening
Contributed by Xiaoqin Liu, M.D., Ph.D. and Aaron R. Huber, D.O.
Mucosal tearing and ulceration
Contributed by Xiaoqin Liu, M.D., Ph.D. and Aaron R. Huber, D.O.
Fungating / exophytic lesion
Polypoid lesion
Ulcerated lesion
Cavitary lesion
Contributed by Xiaoqin Liu, M.D., Ph.D. and Aaron R. Huber, D.O.
Well differentiated carcinoma
Moderately differentiated carcinoma
Poorly differentiated carcinoma
Carcinoma with pagetoid cells
Keratinizing well differentiated carcinoma
Desmoplastic changes
Lymphovascular invasion
p40 stain
Kreyberg stain
Contributed by Saadiya Nazli, M.D. and Catherine E. Hagen, M.D.
EGD area of nodularity
Images hosted on other servers:
Lugol iodine staining
Epidermoid metaplasia
Contributed by Saadiya Nazli, M.D. and Catherine E. Hagen, M.D.
Low grade dysplasia
High grade dysplasia (HGD)
HGD, cytologic changes
HGD, abrupt transition
Epidermoid metaplasia and HGD
Epidermoid metaplasia
Invasive SCC
EMR
Squamous dysplasia screening and treatment
Images hosted on other servers:
Squamous papilloma with warty surface
Squamous papillomatosis
Contributed by Yukihiro Nakanishi M.D., Ph.D.
Esophageal polypoid lesion
Images hosted on other servers:
Illustration of T category and N category staging
Stages of throat cancer
Various stages
Contributed by Rondell P. Graham, M.B.B.S.
Sheets of cells
Low grade to high grade carcinoma
Loss of SMARCA4 (BRG1)
Images hosted on other servers:
Linear, dark blue, submucosal dilated veins
Partially thrombosed after sclerotherapy
Images hosted on other servers:
Inflamed varix
Images hosted on other servers:
Mass penetrating the muscularis propria
Images hosted on other servers:
Large polypoid mass
AFIP images
Large plaque of carcinoma
AFIP images
Squamous spikes covered by keratin
Images hosted on other servers:
Giant cell foreign body reaction
Images hosted on other servers:
Small bowel carcinoid
Images hosted on other servers:
Carcinoid tumor
Images hosted on other servers:
Neurosecretory granules
Greenson: 2019
IARC: 2019
Lamps: 2015
Montgomery: 2017
Montgomery: 2017
Odze: 2022
Saba: 2015
Sharma: 2015
Srivastava: 2023
Yantiss: 2021
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