Question 126

Question:

A 46 year-old white male with a family history of esophageal adenocarcinoma presents complaining of heartburn. On endoscopy, a crescent-shaped area of erythematous mucosa is seen that extends above the gastroesophageal junction. A biopsy of this area of mucosa is taken. What histological features will most likely be seen on H&E stain?

Correct Answer: A.  Columnar epithelium with goblet cells

This erythematous mucosa is likely Barrett’s esophagus, or metaplasia of the normal squamous epithelium of the distal esophagus to columnar epithelium. This usually occurs in the setting of gastroesophageal reflux. Barrett’s is considered pre-malignant for esophageal adenocarcinoma, but not for squamous cell carcinoma. Goblet cells are mucous-secreting cells that will easily be seen in Barrett’s on H&E stain. Parietal cells are not associated with the development of Barrett’s – furthermore, they would not easily be seen on H&E stain. Transitional epithelium is seen in the urinary tract.