Esophagitis and Barrett Esophagus

Blythe K. Gorman, MD

Key Facts

Clinical Issues

Endoscopic correlation is required
- Clinical correlation is wise
Correlate with biopsy if available

Cytopathology

Reactive atypia may be marked in setting of esophagitis or ulcer
- Smooth, uniform nuclei, normal N:C ratio, prominent nucleoli, streaming, no single atypical cells, no 3D clusters
If Barrett esophagus is diagnosed, report presence or absence of dysplasia
True goblet cells: Mucin vacuoles ≥ 3x size of nucleus
Morphologic overlap between reactive atypia and dysplasia

Pap-stained esophageal brushings are seen. (A) Candidal esophagitis shows reactive squamous cells

, yeast, and pseudohyphae

. (B) This reflux esophagitis has a flat, cohesive sheet of reactive cells. The nuclei

have smooth contours, nucleoli, and fine chromatin. (C) Radiation esophagitis shows cells with cytoplasmic vacuoles

and a 2-tone cytoplasm. The nuclei are large with vesicular chromatin

, and the N:C ratio is nearly normal. (D) Ulcerative esophagitis shows marked reactive atypia and neutrophils in the background. The nuclei are uniformly enlarged with prominent nucleoli and vesicular chromatin