Friends of Endoscopy
  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors
  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors
Search
Picture
​

Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
Become a Better Endoscopist ! 

Mucosal irregularity in Barrett's

18/8/2021

Comments

 
Picture
This 'lesion' was barely visible within in a Barrett's segment on white light. However, after acetic acid and with NBI it's more obvious. 
WHAT IS THE LIKELY HISTOLOGY?
a) Barrett's LGD
Usually invisible or just a red, flat patch
b) HGD
Subtle change in crypt pattern but with little nodularity?
c) IMca
This was my own guess but it was wrong...
d) Invasive cancer
Yes, superficial invasion (100 microns) and poor differentiation!
explanation
I removed this lesion without worrying too much about the subtle 'depressed' growth pattern and the small, round crypts in the centre of the lesion.  However, I was surprised to see the pathology report of a superficially invading adenocarcinoma, with poor differentiation to boot!!!   This finding makes the advice on 'further treatment' more complex.  As you know, in both the upper and lower GI tract, the finding of 'lymphovascular invasion' (LV) is probably the most 'ominous sign' that a patient needs surgery (or chemo-radiotherapy in case of the oesophagus).  Poor differentiation is 'bad', but less bad than LVI. 

​Depth of invasion is also important and in Barrett's you are 'allowed' invasion to about 500 microns below the muscularis mucosa.  The corresponding 'safe margin' in SCC's is only 200microns.  In this case the depth of invasion was only about 100 microns, leaving 'poor differentiation' as the only 'bad sign'.  The patient wasn't a surgical candidate and refused CRT.  This was 3 years ago and so far all is well!  

By the way, the histopathologists do have a more difficult job than you perhaps imagine, measuring the depth of invasion in Barrett's cancer.  This is because they often see several bands of muscularis mucosa, so called 'duplication of the muscularis mucosa'.  Elsewhere in the GI tract, the muscularis mucosa is a single band of smooth muscle.  They measure the depth of invasion from the top of the muscularis mucosa down the the deepest point of invasion.  However, if there are several bands of muscularis mucosa, which one do you measure from?!?    Below is an example to illustrate the dilemma.  
Picture
Picture
Comments

    Categories

    All
    Barrett's
    Cancer
    Cancer Syndromes
    Colitis
    Colorectum
    Corrosive Ingestion
    Crypt Pattern
    Difficulty: Hard
    Difficulty: Moderate
    Difficulty: Very Hard
    Duodenum
    Eosinophilic Oesophagitis
    EUS
    Foveolar Metaplasia
    Gastric
    Gastroscopy
    GI Bleeding
    Histology
    HPB
    Ileum
    Immunosuppression
    Infection
    Local Recurrence Of Barrett's Ca.
    Lymphoma
    Mixed Polyp
    Mucosal Prolapse Syndrome
    NET
    Non-lifting Sign
    Oesophagus
    Opinion Piece!
    Pharynx
    Polyp
    Polypectomy
    The Basics
    TSA

  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors