Premalignant lesions
Squamous dysplasia

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

Revised: 22 January 2018, last major update May 2013

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

PubMed Search: Squamous dysplasia[TIAB] esophagus

Cite this page: Weisenberg, E. Squamous dysplasia. website. Accessed November 17th, 2018.
Definition / general
  • Also called esophageal intraepithelial neoplasia (EIN), CIS when full thickness
  • Frequently found adjacent to carcinoma especially in superficial tumors and in tumors when neoadjuvant therapy not performed (Cancer 1987;59:783)
  • Same risk factors as esophageal squamous cell carcinoma
  • High grade but not low grade dysplasia is risk factor for invasive disease (Cancer 1994;74:1686)
  • May be distant from main lesion, suggesting a field effect
Gross description
  • Normal, erythematous mucosa or plaques / nodules; highlighted by application of Lugol solution (Cancer 1998;83:220) or toluidine blue on mucosal surface
Microscopic (histologic) description
  • Low grade (abnormal cells limited to basal half of epithelium) or high grade (abnormal cells in upper half of mucosa); nuclear enlargement, pleomorphism, hyperchromasia, mitotic figures; epithelial buds bulge into the stroma
  • Traditional 3 grade system: grade 1 (regular buds, same size), grade 2 (regular buds, variable size), grade 3 (buds of varying length and width with irregular contours); now a two tiered system, low grade (formerly grade 1) and high grade (encompassing grade 2 and grade 3) is preferred (Am J Surg Pathol 1989;13:685)
  • Dysplastic involvement of submucosal gland ducts may mimic invasion; may have pagetoid spread of dysplastic cells
  • Reactive epithelial changes associated with severe inflammation may necessitate a diagnosis of indefinite for dysplasia; rebiopsy after treatment
  • Basal squamous dysplasia: abnormal cells are confined to basal half or 2/3 of epithelium
Microscopic (histologic) images

Images hosted on PathOut server:

Low grade dysplasia

Almost full thickness epithelial disorganization

Pagetoid high grade dysplasia

Suspicious but not diagnostic of invasive carcinoma

In situ carcinoma involving submucosal ducts

Basal squamous dysplasia:

Small dysplastic basaloid cells

Low magnification

Medium magnification

High magnification

High grade dysplasia due to pleomorphic and hyperchromatic nuclei, although not full thickness

Images hosted on other servers:

In situ carcinoma with adjacent normal mucosa

Differential diagnosis
  • Microinvasive squamous cell carcinoma: usually larger keratinized cells with more atypia and pleomorphism than dysplasia