PATHOLOGIC SLIDES METAPLASIA

1. What normal tissue elements are present? What is the organ?

The organ is the esophagus proximal to esophagogastric juntion. The normal tissue elements present
include the mucosal surface of the esophagus covered by stratified squamous epithelium. There also
appears to be a muscularis mucosa present.

2. Epithelial cells:
a. What types of epithelial cells are present?

There are both stratified squamous epithelial cells and also what appear to be columnar epithelia with
goblet cells and cilia.

b. Which types are usually found in this anatomic location, and which are
abnormal in this location?

The esophagus is usually stratified squamous, the columnar epithelia with goblet cells and cilia are
abnormal, as they are normally located in the intestinal tract. (The columnar epithelia with goblet cells
are also not normal at the gastroesophagal junction).

c. How about non-epithelial cells—can you find any that might contribute to
the pathology?

There appears to be abnormal mesenchymal stem cells beneath the columnar epithelia. These may be
contributing to the proliferation of intestinal epithelia within the esophagus. They may become
cancerous.

3. What is/are the basic pathologic process(es): inflammatory, infectious, neoplastic,

degenerative, congenital, etc? What’s you differential diagnosis?

This is most likely a metaplasia of esophageal stratified squamous epithelia to intestinal columnar
epithelia with cilia and goblet cells. Gastric reflux may be inducing this change. This is called Barret
Esophagus. There is an increased risk of adenocarcinomas in regions of Barret esophagus.

Differential diagnoses for his heart burn include, hiatal hernia, obesity, Zollinger-Ellison syndrome
(which can be present with increased gastric acidity due to gastrin production ), or stomach ulcers.