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Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
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Two identical nodules ?

12/12/2020

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Picture
​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 !
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