Esophagus
Premalignant
Squamous dysplasia
Author: Elliot Weisenberg, M.D.
Topic Completed: 1 May 2013
Minor changes: 30 September 2020
Copyright: 2003-2021, PathologyOutlines.com, Inc.
PubMed Search: Squamous dysplasia[TIAB] esophagus
Table of Contents
Definition / general | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosisCite this page: Weisenberg E. Squamous dysplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/esophagussquamousdysplasia.html. Accessed October 25th, 2021.
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
Treatment
- Excision, including endoscopic mucosal resection (Endoscopy 2007;39:24)
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
