Esophagus
Premalignant lesions
Barrett related dysplasia

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 19 January 2018, last major update April 2013

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Barrett[TIAB] related dysplasia esophagus

Cite this page: Weisenberg, E. Barrett related dysplasia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusdysplasia.html. Accessed December 16th, 2018.
Definition / general
  • Unequivocally neoplastic epithelium that does not invade lamina propria, associated with Barrett esophagus (BE)
Terminology
Clinical features
Prognostic factors
Treatment
  • Low grade dysplasia: antireflux therapy and increased surveillance
  • High grade dysplasia: rebiopsy immediately to rule out missed invasive carcinoma; possibly esophagectomy; recommended to get second opinion on dysplastic biopsies from an experienced GI pathologist
  • Photodynamic therapy: less effective on papillary lesions or distal esophagus lesions (Am J Surg Pathol 2004;28:1466); may cause "buried dysplasia" (Am J Surg Pathol 2007;31:403)
  • Endoscopic mucosal resection: endoluminal therapeutic technique with low morbidity and no mortality; offers improved diagnosis and staging compared with biopsy and ultrasound but resection is often incomplete and there are high rates of persistence / recurrence (Am J Surg Pathol 2005;29:680, Postgrad Med J 2007;83:367)
Gross description
  • Normal appearing or nodule, erosion or polyp
Gross images

Images hosted on other servers:

High grade dysplasia

Dysplasia (grade unspecified)

Microscopic (histologic) description
  • Designate low or high grade based on basal (low grade) or apical orientation (high grade) of nuclei (similar to colon criteria); both grades show mucus depletion and prominent cytoplasmic basophilia
  • Low grade dysplasia: preservation of crypt architecture with minimal distortion, atypical nuclei usually limited to basal half of the crypts; variable hyperchromasia, overlapping cell borders with nuclear crowding and irregular nuclear contours; usually shows maturation towards lumen; abrupt vs gradual transition from typical to atypical epithelium favors dysplasia; diagnose dysplasia cautiously in presence of inflammation; considerable interobserver variability exists in distinguishing no dysplasia from low grade dysplasia / indefinite for dysplasia (Histopathology 2007;50:920)
  • High grade dysplasia: more severe atypia and architectural complexity than low grade dysplasia, often with villiform configuration of mucosal surface, more nuclear pleomorphism and hyperchromatism, often nuclear stratification to crypt luminal surface; often easier to diagnose at low power due to nuclear hyperchromasia
  • Dysplasia limited to basal crypts with surface maturation (crypt dysplasia): uncommon but commonly associated with classic dysplasia and may occur with adenocarcinoma (Am J Surg Pathol 2006;30:423); additional levels are recommended if found in isolation to determine if typical dysplasia or adenocarcinoma may be present
  • Tubular adenoma: dysplasia in a pedunculated lesion, follow up as dysplasia in BE not as a sporatic adenoma
  • Nonadenomatous (foveolar) dysplasia: rare, poorly understood biology and natural history; back to back crypts with high N/C ratio, round to oval irregular nuclei, open chromatin, prominent nucleoli; absence of surface maturation; usually considered high grade dysplasia (Mod Pathol 2010;23:834, Hum Pathol 2013;44:1146)
Microscopic (histologic) images

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Images hosted on PathOut server:

Low grade dysplasia:

Lower half of gland

Upper half of mucosa

Dysplasia in lower half of glands

Dysplasia of surface foveolar epithelium



High grade dysplasia:

Marked distortion of glandular architecture

Various images

Dysplastic epithelium replaces Barrett mucosa



Other:

Tubular adenoma

Reactive changes



Images contributed by Dr. Mark R. Wick:

Low grade dysplasia

Metaplasia, high grade dysplasia

Metaplastic

Metaplasia with dysplasia



Images hosted on other servers:

Low grade dysplasia:

Various images



High grade dysplasia:

Various images



Other:

Various images

Reactive images (click on links)

Positive stains
Differential diagnosis
  • Baseline atypia: glands at base of Barrett mucosa have enlarged, slightly hyperchromatic cells with some stratification and increased mitotic activity but normal surface epithelium
  • Intramucosal adenocarcinoma: neoplastic cells infiltrate into lamina propria, usually as single cells or small clusters
  • Reactive changes: if neutrophils present, be conservative in diagnosing dysplasia; reactive cells have more uniform atypia / less pleomorphism, lower nuclear / cytoplasmic ratio, round and regular nuclear contours, basal nuclei (University of Washington: Pitfalls in the Diagnosis of Dysplasia [Accessed 19 January 2018])