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Barrett Esophagus : Prognosis

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Prognosis: Barrett esophagus (BE) is a preneoplastic lesion that increases the risk for subsequent development of esophageal adenocarcinoma (EAC). The metaplasia-dysplasia-adenocarcinoma sequence is well-recognized in BE. Patients with non-neoplastic BE develop low-grade dysplasia (LGD) at the rate of 4.3% per year, and high-grade dysplasia (HGD) at the rate of 0.9% per year.

The annual risk of progression to EAC in patients with nondysplastic BE is approximately 0.12-0.33% per year. The risk is much higher in patients with dysplasia associated with BE. The rate of progression to EAC in 5 years is about 50% with HGD and 20% with LGD. With LGD, accurate estimation of the risk of progression is complicated by the lack of reproducibility in the diagnosis of LGD.

Although most cases of BE do not develop into EAC, there are no well-established prognostic markers to help determine cases that will progress. Some studies have suggested that cases with abnormalities in CDKN2A and TP53 may have increased risk of progression.

About this image: High-grade dysplasia in BE (higher magnification of the previous image). The glands are variable in size and shape. There is nuclear pleomorphism with piling up of nuclei. There is nuclear hyperchromasia, high N:C ratios, prominent nucleoli and increased mitotic activity as well. When viewed at low magnification, the dysplastic areas stand out due to their basophilia and loss of mucus.

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