What is the level of mayhem?
This patient attends for Barrett's surveillance
WHAT IS YOUR DIAGNOSIS?
a) Barrett's without dysplasia
A nodule within Barrett's is NEVER 'normal'!
LGD is flat, not nodular!
Good guess! Although your guess actually proved to be wrong
Small crypts + nodule = correct!
e) invasive cancer
Nodule should have been larger and without those small crypt openings
My 'rules of thumb' when assessing Barrett's is as follows:
1) crypts look different in a distinct patch but the area is flat = LGD
2) areas of superficial ulcers within the Barrett's = widespread LGD
3) crypts look different and there is a distinct nodule = HGD
4) crypts are tiny small and there is a nodule = IMca
5) there are no crypts and there is larger nodule = invasive cancer
Of course this isn't fool proof ! After all, it's very difficult to distinguish HGD from IMca even on histology! However, it gives you a starting point on how to assess Barrett's and what you should enter on that Histopathology request form. Remember that your pathologists need your help!