Two identical nodules ?

​Here are two cases of a small nodule within Barrett's (top and bottom row). Of course you know that a nodule within Barrett's should ALWAYS be viewed with suspicioun.  Naturally, both nodules were sampled as well as the surrounding unremarkable looking Barrett's.  One case turned out to be non-dysplastic but the other were reported to harbour IMca. 
WHICH NODULE IS DYSPLASTIC? 

Case A (top row)

INCORRECT!

Case B (bottom row)

CORRECT!

explanation

On facebook, this proved a very difficult question and only half correctly identified Case B (bottom row) as being dysplastic. 

Must admit that I felt uncomfortable about both nodules, as in my book, a nodule within Barrett's is never "right".  In the end, I actually removed both.   Just to be on the safe side. 

Incidentally, my own simple 'rule of thumb' when assessing Barrett's is as follows: 

1. patch of Barrett's with a different surface pattern = HGD 
2. patch of Barrett's with a different surface pattern + nodularity = IMca 
3. Barrett's nodule without any discernible surface pattern = poorly differentiated ca. 

 Low grade dysplasia is invisible endoscopically !