Gastrointestinal Pathology

Figure 1.14 Endoscopic submucosal dissection (ESD) procedure. A flat neoplastic lesion is seen in panel 1–2 after staining with cresyl violet. The margins are incised (panel 3) with the endoscope retroflexed (black tube). The submucosal plane is dissected with a needle knife (panel 4). The final resection site (panel 5) and corresponding resection specimen prepared for pathology processing (panel 6).

Figure 1.15 Endoscopically resected en bloc well‐differentiated adenocarcinoma 28 × 17 mm with superficial submucosal invasion and no lymphovascular invasion and negative horizontal and vertical margins. This sample meets criteria for endoscopic curative resection.

Figure 1.16Large mediastinal lymph node sampled with EUS‐FNA. The needle is seen entering from the upper right of the screen into the tumor in the center of the image.

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Anthony R. Mattia1, Gregory Y. Lauwers2, Michael B. Wallace3 and Till S. Clauditz4

1 Newton‐Wellesley Hospital, Newton, MA, USA

2 Moffitt Cancer Center, Tampa, Florida, USA

3 Mayo Clinic, Jacksonville, Florida, USA

4 Department of Pathology, University‐Medical Center, Hamburg, Germany

The esophagus has a pearly white and smooth surface under which a network of small vessels is seen ( Figure 2.1) except for the distal esophageal sphincter where prominent longitudinal and palisading vessels (exceeding 100 mm in diameter) are observed and used to define the esophagogastric junction.

The esophageal mucosa is composed of a non‐keratinizing flat stratified squamous epithelium, lamina propria, and muscularis mucosae ( Figure 2.2; Table 2.1). The squamous epithelium is 10–20 cell layers thick measuring 300–500 μm in thickness. The prickle cells contain a large quantity of cytoplasmic glycogen, which stains positively with periodic acid–Schiff (PAS). The basal proliferative zone, the cuboidal or polyhedral basal and parabasal cells account for 15% or less of the epithelial thickness. A small number of specialized cell types, including T lymphocytes, Langerhans cells, endocrine cells, and melanocytes are also present in the deep/parabasal epithelium. The lamina propria consists of loose connective tissue with scattered inflammatory cells, vessels, nerves, and small mucous glands. The lamina propria papillae normally extend into the epithelium for 1/3–1/2 of its thickness. The muscularis mucosae is a thick layer of smooth muscle bundles oriented longitudinally. In the distal 1–2 cm of the esophagus, the basal zone, papillae, and intraepithelial cells may be more prominent, and include rare eosinophils. Esophageal mucosal biopsies typically include the squamous epithelium and scant lamina propria. The muscularis mucosae is seldom present, and better identified in esophageal mucosal resection specimens.