Squamous dysplasia

Last author update: 1 May 2013
Last staff update: 2 June 2022

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PubMed Search: Squamous dysplasia[TIAB] esophagus

Elliot Weisenberg, M.D.
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Cite this page: Weisenberg E. Squamous dysplasia. website. Accessed February 7th, 2023.
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

AFIP images

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
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