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Difficulty: EasyPathology and Biopsy Interpretation

A 50-year-old man undergoes an upper gastrointestinal endoscopy to evaluate a 5-year history of chronic heartburn. During the procedure, the gastroenterologist notes an area of abnormal-appearing mucosa in the distal esophagus and takes a biopsy. The resulting pathology report states: 'Replacement of the normal stratified squamous epithelium by columnar epithelium with interspersed goblet cells. No dysplasia or invasive cells are identified.' Based on this biopsy interpretation, what is the most likely diagnosis?

  1. Barrett esophagusAnswer
  2. B
    Esophageal adenocarcinoma
  3. C
    Eosinophilic esophagitis
  4. D
    Squamous cell carcinoma
  5. E
    Reflux esophagitis

Answer

Barrett esophagus
The correct answer is Barrett esophagus. The biopsy explicitly describes the replacement of native stratified squamous epithelium with columnar epithelium containing goblet cells in the distal esophagus. This process is known as intestinal metaplasia and is the definitive pathologic requirement for diagnosing Barrett esophagus, which typically develops as a complication of chronic gastroesophageal reflux disease.

Step-by-Step Solution

1
Analyze the patient's clinical presentation.
The patient has a long history of chronic heartburn, which is a major risk factor for complications of gastroesophageal reflux disease (GERD).
Establishing the clinical context helps narrow the differential diagnosis for esophageal pathology.
2
Interpret the biopsy findings from the pathology report.
The report describes columnar epithelium with goblet cells replacing the normal stratified squamous epithelium.
Identifying the specific histologic changes is required to establish the correct definitive diagnosis.
3
Correlate the histology with the specific condition.
Intestinal metaplasia (goblet cells in columnar epithelium) in the distal esophagus is diagnostic of Barrett esophagus.
This histologic hallmark distinguishes Barrett esophagus from simple reflux esophagitis or malignancies.

Key Concept

Intestinal metaplasia, defined by the presence of goblet cells replacing the normal squamous epithelium in the distal esophagus, is the diagnostic histologic feature of Barrett esophagus.
Estimated Time:45s
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Topics

Pathology and Biopsy Interpretation

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