Esophagus Histology

Front 1

The esophagus measures approximately ___ cm in length in adults.

Back 1

23-25cm

Front 2

The esophagus begins and ends approximately ____ cm and ___cm from the adult incisor teeth.

Back 2

15-40cm
15 cm start of cervical segment
40 cm is pyloric sphincter

Front 3

The mid thoracic segment of the esophagus begins at the ____ (anatomic landmark).

Back 3

Tracheal bifurcation

Front 4

The cervical portion of the esophagus is bounded by the ____ nerves and overlapped by which gland?

Back 4

Recurrent laryngeal nerves.

Thyroid gland.

Front 5

The angle of ___ forms a sharp angle between the distal esophagus and the fundus of the stomach.

Back 5

His

Front 6

What is the Z line?

Back 6

A grossly visible line formed at the junction of esophagus and stomach.

Front 7

Glycogenic Acanthosis presents as ___ ___ or ____ ____ on the mucosal folds, and is a variant of normal gross anatomy.b

Back 7

White nodules or small plaques.

(May be confused with monilial plaques or leukoplakia).

Front 8

T/F. Heterotopias of the esophagus can include stomach, sebacious glands, thyroid, pancreatic tissue.

Back 8

True

Front 9

A narrowing of the lower part of the esophagus near the GE junction is called?

Back 9

Schatzki's ring

Type A: above the Z line
Type B: below the Z line.

Front 10

The esophagus mucosa consists of a

a) nonkeratinizing, stratified squamous mucosa
b) simple columnar mucosa
c) transitional mucosa

Back 10

A

Front 11

What are the four layers of the esophagus?

Back 11

Mucosa, submucosa, muscularis propria, serosa.

Front 12

The mucosa layer consists of (name 3 layers)

Back 12

1) Non keratinizing stratified squamous epithelium
2) Lamina propria
3) Muscularis mucosa

Front 13

Normal basal cell layer comprises ___% of the epithelium.

Back 13

10-15%, may be more in the most distal segment.

Front 14

The upper extent of the basal layer is defined as the layer in which the nuclei are separated by a distance of ___.

Back 14

equal to the nuclei's diameter.

Front 15

PAS stain shows that the basal layer of the epithelium is
a) glycogen rich
b) glycogen poor

Back 15

B

Front 16

T/F

Occasional lymphocytes within the basal cell layer of the epithelium is a normal finding.

Back 16

True
Like the rest of the GI tract, lymphocytes are (CD3+/CD8+) cytotoxic T cells.

Front 17

Progressing superficially, epithelial cells become more flattened and nuclei more ___.

Back 17

pyknotic.

Front 18

Patients with GERD typically have an (increased/decreased) proliferative activity of the basal cells.

Back 18

increased

Front 19

Stem cells in the esophagus consist of a single layer of cells and have a (high/low) proliferative activity, being Ki67 (+/-)

Back 19

They have a low proliferative activity and are Ki67 negative.

Ki67 positive cells have high proliferative activity

Front 20

T/F

The lamina propria consist of areolar connective tissue, constains vascular structures, scattered inflammatory cells, and mucus secreting cells.

Back 20

True

Front 21

T/F

Presence of inflammatory cells in the lamina propria is consistent with acid reflux

Back 21

False, they are a normal finding

Front 22

Lymphocytes in the lamina propria consist of

Back 22

Mostly CD4 T cells with some IgA B cells and IgG and igM B cells.

Front 23

The Muscularis Mucosae typically becomes (thinner, thicker) distally in the esophagus

Back 23

thicker

Front 24

Esophageal cardiac type glands are diffusely scattered in the ___ layer through all levels of the esophagus, predominating in distal and proximal regions.

Back 24

Lamina propria.

They function to secrete neutral mucin and resemble pyloric glands lined by gastric foveolar like cells.

Front 25

The submucosa consists of loose connective tissue containing vessels, nerve fibers (including the ____ plexus), and submucosal glands.

Back 25

Meissner

Front 26

T/F

In contrast with glands in the lamina propria, submucosal glands stain with PAS-D and Alcian blue.

Back 26

True. Cardiac-type glands in the lamina propria are typically neutral mucin producing glands.

Front 27

The proximal 5% of muscularis propria is composed entirely of (striated, smooth) muscle.

Back 27

Striated

Front 28

Auerbach's plexus is found between which layers?

Back 28

Circular muscle and Longitudinal muscle layers.

Front 29

Scleroderma and Achalasia affect which muscular layer and in what way?

Back 29

Circular muscle layer

(atrophy in scleroderma and hypertrophy in achalasia).

Front 30

T/F

The majority of the esophagus has a serosa layer.

Back 30

False, most are lined with fascia.

Front 31

T/F

Lymphatics in muscular layer are oriented in a longitudinal direction, facilitating intramucosal and submucosal spread of tumor.

Back 31

True

Metastasis patterns are often varied and unpredictable

Front 32

The layer of ganglion cells between the circular and longitudinal layers of muscle are called

Back 32

Auerbach's plexus

Front 33

Barrett's esophagus is defined as replacement of normal epithelium with ____ epithelium.

Back 33

Columnar

Front 34

What type of mucin producing cells are typical in Barrett's esophagus? What do they stain with?

Back 34

Goblet cells, stains positive with Alcian blue at ph 2.5.

Front 35

Endoscopic abnormality (macro and microscopic) in Barretts esophagus is useful except in (3 cases)

Back 35

1) patients with highly irregular Z line
2) in children of 1st decade (rarely exhibit metaplasia)
3) patients with long term PPI may not yield goblet cells

Front 36

Describe the pathology

Back 36

Barrett's esophagus, with red velvety mucosa which are columnar epithelium extending well into the tubular esophagus.

Front 37

Goblet cells in Barrett's may be associated with mucin antigens ___ and ___.

Back 37

MUC1, MUC6

Front 38

Multilayered epithelium consist of apical ___ cells overlying a squamous epithelium.

Back 38

Columnar
(mucin producing)

-may represent early/transitional phase of columnar metaplasia in Barrett's esophagus

Front 39

Diagnosis is Barrett's esophagus is established from taking samples from where to where?

Back 39

Stomach just distal to upper end of gastric folds then up every 1-2 cm until squamous epithelium is reached.

Front 40

Barrett's esophagus is defined as less than ___ cm of columnar lined esophagus with goblet cells.

Back 40

3

Front 41

Intestinal Metaplasia of the stomach is usually caused by ___ and ___.

Back 41

GERD and Helicobacter

Front 42

Describe the Pathology

Back 42

Reflux esophagitis, with basal cell hyperplasia and lengthening of the papillae, extending almost to the surface of the mucosa (arrows).

Front 43

Reflux-associated squamous hyperplasia (RASH) consists of basal cell hyperplasia of greater than __% and extension of paillae into ___ of the epithelium.

Back 43

15%,
upper third

Remember that RASH is a nonspecific reaction of esophageal injury

Front 44

T/F

RASH (reflux assoc squamous hyperplasia) can be seen in distal 3cm of esophagus in majority of patients without evidence of reflux.

Back 44

True

Front 45

Other than RASH, what feature could be an early evidence of GERD?

Back 45

dilated intercellular spaces, intraepithelial eosinophils.

Front 46

Intraepithelial eosinophils are indicative of

Back 46

a) alkaline reflux
b) allergic disorders
c) infections
d) GERD

Front 47

Intraepithelial neutrophils can be indicative of

Back 47

a) acute esophagitis
b) GERD (less sensitive)

Front 48

The use of DIS (Dilated intercellular spaces), IEE (intraepithelial eosinophils), IEN (intraepithelial neutrophils) as histologic criteria of GERD has what advantage?

Back 48

Localization and orientation of the biopsy is not important.

Front 49

Barrett's mucosa has a risk of evolving into

Back 49

Adenocarcinoma