This example shows a dilated gland with luminal debris. This is one of several findings that raises the question of associated adenocarcinoma. Image

Complicated architecture including a tightly compact arrangement accompanied by disturbing cytological alterations. Tendencies towards villous change is also a feature.

Nuclei are hyperchromatic, enlarged and arranged in a jumbled fashion. Note the extensive lack of basal polarity. Identifiable nucleoli can be seen in the dark and enlarged neoplastic cells.

Dysplasia is defined as unequivocal neoplastic change without invasion and shows a variety of cytological and architectural abnormalities. Low-grade dysplasia, high-grade dysplasia and intramucosal carcinoma exist on the continnum. High-grade dysplastic epithelium involves the full length of the crypts and surface epithelium.

Dysplastic features include architectural distortion of glands including jagged contours, branching, budding and crowding. Nuclear features include size and shape variation, hyperchromatism and increased N/C ratio. Markedly enlarged hyperchromatic, pleomorphic cells and loss of polarity are no longer low-grade dysplastic features, but place the lesion in the high-grade territory (Iacobuzio, Rosai).

Intramucosal carcinoma is defined as penetration through the basement membrane into the lamina propria. The neoplastic glands can involve the muscularis musosae, but not beyond. Unfortunately, most biopsies will not be deep enough to assess submucosal invasion (Rosai).

In many centers today, endoscopic therapy is an established treatment of Barrett’s-esophagus-related neoplasia, including high grade and intramucosal carcinoma. Esophagectomy is often reserved for selected cases with submucosal invasion, lymph node involvement, or unsuccessful endoscopic therapy.

• Esophagus : Barrett Esophagus (Intestinal Metaplasia)

• Esophagus : Glandular Dysplasia, Low Grade

• Esophagus : Adenocarcinoma