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Histopathology of Barrett’s Esophagus and Early-Stage Esophageal Adenocarcinoma: An Updated Review

Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Gastrointest. Disord. 2019, 1(1), 147-163; https://doi.org/10.3390/gidisord1010011
Received: 24 October 2018 / Revised: 20 November 2018 / Accepted: 22 November 2018 / Published: 27 November 2018
Esophageal adenocarcinoma carries a very poor prognosis. For this reason, it is critical to have cost-effective surveillance and prevention strategies and early and accurate diagnosis, as well as evidence-based treatment guidelines. Barrett’s esophagus is the most important precursor lesion for esophageal adenocarcinoma, which follows a defined metaplasia–dysplasia–carcinoma sequence. Accurate recognition of dysplasia in Barrett’s esophagus is crucial due to its pivotal prognostic value. For early-stage esophageal adenocarcinoma, depth of submucosal invasion is a key prognostic factor. Our systematic review of all published data demonstrates a “rule of doubling” for the frequency of lymph node metastases: tumor invasion into each progressively deeper third of submucosal layer corresponds with a twofold increase in the risk of nodal metastases (9.9% in the superficial third of submucosa (sm1) group, 22.0% in the middle third of submucosa (sm2) group, and 40.7% in deep third of submucosa (sm3) group). Other important risk factors include lymphovascular invasion, tumor differentiation, and the recently reported tumor budding. In this review, we provide a concise update on the histopathological features, ancillary studies, molecular signatures, and surveillance/management guidelines along the natural history from Barrett’s esophagus to early stage invasive adenocarcinoma for practicing pathologists. View Full-Text
Keywords: Barrett’s esophagus; intestinal metaplasia; low-grade dysplasia; high-grade dysplasia; intramucosal carcinoma; submucosal invasive adenocarcinoma Barrett’s esophagus; intestinal metaplasia; low-grade dysplasia; high-grade dysplasia; intramucosal carcinoma; submucosal invasive adenocarcinoma
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Yin, F.; Hernandez Gonzalo, D.; Lai, J.; Liu, X. Histopathology of Barrett’s Esophagus and Early-Stage Esophageal Adenocarcinoma: An Updated Review. Gastrointest. Disord. 2019, 1, 147-163.

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