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Barrett Esophagus : High-grade Dysplasia

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High-grade Dysplasia (HGD) in Barrett Esophagus (BE): The glands have marked cytologic atypia and architectural abnormalities. There is no surface maturation, i.e. the abnormal features of deep basal glands are also present in the surface epithelium. The glands show overcrowding, angulation, branching, or crypt budding. If cytologic features are sufficiently abnormal, glands with lesser degree of architectural distortion may still be classified as HGD.

Cytologic features include: nuclear enlargement and hyperchromasia, irregularity of nuclear membrane, prominent nucleoli, loss of nuclear polarity, and increased mitotic activity. Some glands show nuclear stratification. Other cases have small crowded glands lined by a single layer of highly atypical cells. Inflammation is usually minimal or absent.

Significance of Dysplasia: Patients with non-neoplastic Barret esophagus develop LGD at the rate of 4.3% per year, and HGD at the rate of 0.9% per year. The rate of progression to cancer within 5 years is about 20% with LGD and about 50% with HGD.

Image courtesy of: Phoenix Bell, MD.

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