Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

  Browse by Author
  Browse by Movies
Volume: Barrett's Esophagus
Chapter: Dysplasia

Are there specific morphometric features, particularly architectural, that correlate with different grades of dysplasia?

H.D. Appelman (Ann Arbor)

Dysplasia in the gastrointestinal tract is defined as unequivocally neoplastic epithelium [1]. The problem with this definition is that it does not indicate exactly what microscopic characteristics make an epithelium unequivocally neoplastic. The decision about what is or is not dysplastic is dependent on the visual perceptions of every pathologist who is asked to identify dysplasia. Part of the diagnosis of dysplasia is based on cytologic changes in cell type from a mature looking columnar cell population with uniform, basal nuclei, to populations of cells that have larger nuclei in relation to cytoplasmic volume, nuclei that vary in size and shape, more frequent mitoses that include atypical forms in the cells, and nuclei that are no longer strictly basal, but are stratified. There is also a change in the cytoplasm from specialized to immature; in other words, dysplastic cells are likely to contain less well developed mucus vacuoles or have mature absorptive cell structure. The greater the degree of these changes, the higher the grade of dysplasia.

However, the distinction between the lowest grade of dysplasia and reparative or regenerating epithelium is often very difficult, since they share many cytologic features. As a result, an additional aid in the diagnosis of low-grade dysplasias (LGD) is architectural change, that is, structural mucosal changes that differ from the usual Barrett's architecture and from any architecture that is common in regenerating mucosa. This generally involves clustering of smaller than normal tubules lined by the dysplastic-appearing epithelium, creating an architecture similar to that in a tubular adenoma of the colon. In addition, there may be a change from a flat to a villous surface, although that is a far less common feature of dysplasia. High-grade dysplasia is a much more easily made diagnosis than LGD, based upon the cytologic features alone, but almost invariably, there are architectural alterations that accompany the cytologic abnormalities. Therefore, "dysplasia in Barrett's esophagus is characterized by a combination of architectural and cytological abnormalities" [2]. Such architectural changes are critical ancillary diagnostic criteria especially for LGD. They accompany the cytologic changes and we depend upon their presence to help us make the diagnosis.


1. Riddell RH, Goldman H, Ransohoff DF, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol 1983;14:931-968.

2. Geboes K, Van Eyken P:The diagnosis of dysplasia and malignancy in Barrett's oesophagus. Histopathol 2000;37:99107.

Publication date: August 2003 OESO©2015