John R Goldblum1. 1. Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave L25, Cleveland, OH 44195, USA. goldblj@ccf.org
Abstract
CONTEXT: athologists frequently assess esophageal biopsy specimens to “rule out Barrett esophagus,” as well as to assess for the presence or absence of dysplasia. OBJECTIVE: To review some of the recent controversies in the diagnosis of Barrett esophagus and Barrett-related dysplasia. DATA SOURCES: Sources were the author's experience and review of the English literature from 1978 to 2009. CONCLUSIONS: Although goblet cells are required by the American College of Gastroenterology to confirm a diagnosis of Barrett esophagus, this definition might expand to include columnar-lined esophagus without goblet cells. The recognition of dysplasia in Barrett esophagus remains a difficult task for the surgical pathologist, with difficulties in distinguishing reactive epithelium from dysplasia, low-grade dysplasia from high-grade dysplasia, and even high-grade dysplasia from intramucosal adenocarcinoma.
CONTEXT: athologists frequently assess esophageal biopsy specimens to “rule out Barrett esophagus,” as well as to assess for the presence or absence of dysplasia. OBJECTIVE: To review some of the recent controversies in the diagnosis of Barrett esophagus and Barrett-related dysplasia. DATA SOURCES: Sources were the author's experience and review of the English literature from 1978 to 2009. CONCLUSIONS: Although goblet cells are required by the American College of Gastroenterology to confirm a diagnosis of Barrett esophagus, this definition might expand to include columnar-lined esophagus without goblet cells. The recognition of dysplasia in Barrett esophagus remains a difficult task for the surgical pathologist, with difficulties in distinguishing reactive epithelium from dysplasia, low-grade dysplasia from high-grade dysplasia, and even high-grade dysplasia from intramucosal adenocarcinoma.
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