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esophagus pathology


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list the Congenital defects of the esophagus
agenesis; atresia; fistulas
list the acquired defects of the esophagus
mucosal webs (proximal); schatzki’s ring (distal) varices (portal hypertension (40% mortality w/ rupture)
list the lesions of esophagus related to motor dysphunction
achalasia; hiatul hernia; diverticula; lacerations (Mallory weiss tear)
esophagitis commun cause; histo appearance, complications
acid reflux; inflammatory infliltrate w/ eosiniphils; complications include bleeding stricture and barret metaplasia; infections uncommon but seen in immunocompromised
barret esophagus
11% of pts w/ chronic reflux will develop this. dysplasia of metalastic glandular mucosa may progress to adenocarcinoma (30 fold increased risk). high grade dysplasia progresses to invasive adenocarcinoma in 40%
benign tumors of the esophagus
usually mesenchymal; leiomyoma or other type of stromal tumor
carcinoma of the esophagus most common types
squamous cell and adenocarcinoma
squamous cell carcinoma gross morphology
may demonstrate a fungating exophytic tumor; 2 aflat diffuse neoplasm that infiltrates the wall of the esophagus; 3 an ulcerated excavated mass that grows deeply and invades adjacent structures such as the respiratory tract or aorta
squamous cell carcinoma microscopy
poorly differentiated (by degree of keratinazation in cytoplasm and presence or absence of intercellular bridges)
squamous cell carcinoma prognosis
five year survival rate of 25% because neoplasms often of advancee stage
adenocarcinoma gross findings
80% in distal third of esophagus, 50% including proximal stomach; most are flat and ulcerated; 1/3 polypoid or fungating
adenocarcinoma microscopy
most arise in a background of barret esophagus with high grade dysplasia; usually “intestinal” type; may be composed of obvious glands or comprised of poorly formed tubules or signet ring cells; 75% have lymph node metasteses at time of diagnosis
adenocarcinoa of esophagus prognosis
<30% 5 year survival; esarly detection essential

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