Barrett's Oesophagus

The changing role of the pathologist in the management of Barrett's oesophagus

“…Even so, there remains a current requirement to divide true dysplasia into low grade and high grade categories. In general, low grade dysplasia conforms to the appearances seen in low grade adenomatous dysplasia, especially in the stomach and colorectum . One feature that we find useful for the diagnosis of low grade dysplasia, as against reactive epithelium, is the demonstration of a sharp demarcation between dysplastic and non‐dysplastic epithelium, especially in terms of the nuclear changes (Figure ).…”

“…A failure of maturation to the surface is probably the most important feature for the diagnosis of dysplasia, especially low grade dysplasia. In high grade dysplasia, there are more likely to be architectural abnormalities, often with a villous morphology, and the cytological changes are more advanced, with pronounced loss of surface maturation and nuclear polarity, irregular hyperchromatic nuclei, and a more striking degree of gland crowding . Although there are many publications demonstrating the utility of immunohistochemistry and/or biomarkers in differentiating reactive conditions from dysplasia, we do not find these useful, and do not use any such markers routinely or in referral practice.…”

“…The utility of cytokeratin immunohistochemistry, specifically cytokeratins 7 and 20, to differentiate true CLO from so‐called ultra‐short Barrett's oesophagus, better termed cardia IM (CIM), is one of the more controversial aspects of CLO pathology. Although many eminent workers have advocated its use and have purportedly demonstrated notable differences in cytokeratin subset immunohistochemistry between the two conditions, we believe that it is now generally accepted that similar cytokeratin phenotypes may be seen in CLO and in gastric IM, that this methodology does not provide definitive differentiation, and that its use in routine diagnostic pathology cannot be recommended …”

“…In our view, the indefinite for dysplasia category is one to be promoted and used, when there is diagnostic doubt, not least because there are well‐established strategies and guidelines for its management . Indeed, in the second opinion practice of the senior author, this is one of the commonest diagnoses ultimately made.…”

Rectal bleeding as a symptom of solitary rectal ulcer syndrome mimicking rectal neoplasm on colonoscopy: A case report

“…The differential features of SRUS from rectal cancer are summarized in Table 1. [7][8][9][10] Treatment is based on the severity of the disease and the patient's symptoms, such as the severity of bleeding, constipation, ulcers, and rectal prolapse. Patient education and lifestyle changes are the first steps of treatment.…”