Category Archives: Esophagus

Indications for Esophagectomy

Indications for Esophagectomy

- High grade dysplasia (controversial)

- Intramucosal carcinoma

- Carcinoma

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Esophageal Cancer Staging

Esophageal Cancer Staging

T1     invasion into lamina propria OR submucosa

T2    invasion into muscularis propria

T3     invasion into adventitia

T4     invasion into adjacent organs
N0

N1    regional nodes metastasis
M0

M1   distant metastases

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Reflux Esophagitis

Reflux Esophagitis

Histology:

- basal cell hyperplasia >1/3 thickness

- dermal papillae > 2/3 thickness

- chronic inflammation with lymphocytes, plasma cells

- eosinophils present think Gastroesophageal reflux disease GERD, eosinophilic esophagitis

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Glycogenic Acanthosis

Glycogenic Acanthosis

Gross appearance:

- multiple white plaques < 1 cm

Histology:

- acanthosis with glycogen-packed cells

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Varices

Varices

- secondary to portal hypertension

Cause of portal hypertension

North America – alcoholic cirrhosis

Worldwide – viral hepatitis, Schistosomiasis

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Mallory-Weiss Tear

Mallory-Weiss Tear

- longitudinal laceration

- secondary to iatrogenic instrumentation, alcohol

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Esophagus Hernia

Esophagus Hernia

- sliding hernia

- para-esophageal hernia

Complications: ulcer, bleed, perforation, strangulation of para-esophageal hernias

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Esophagus Diverticulum

Esophagus Diverticulum

Diverticulae

- Zenker’s diverticulum – above upper esophageal sphincter (UES), mass in neck, secondary to dysfunction in cricopharyngeal muscle

- mid-esophageal diverticulum

- epiphrenic diverticulum – above lower esophageal sphincter (LES)

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Achalasia

Achalasia

Pathophysiology:

- T cell mediated destruction and disruption of myenteric plexus resulting in decreased peristalsis, relaxation of lower esophageal sphincter (LES) with swallowing and decreased resting tone of LES

Pathology:

- dilation of the esophagus proximal to LES

- hypertrophy or thinning of muscularis

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Esophagus Cysts

Esophagus Cysts

- duplication (have mucosa, submucosa, muscular layer)

- bronchogenic (cartilage in wall)

- neuroenteric (lined by intestinal mucosa)

- developmental (ciliated or squamous lined with smooth muscle)

- inclusion (lined by squamocolumnar epithelium) –> retention cysts (mucoceles, from obstructed submucosal gland ducts)

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