Patient B: 42 year old male with severe heartburn. Endoscopy showed HH with severe exudative esophagitis. The patient was treated with high dose Omeprazole. Several months later endoscopy showed a 5 cm columnar mucosa. Biopsy showed high grade dysplasia as well as invasive carcinoma.

1. High grade dysplasia in Barrett’s esophagus (high power):

Figure 1

The high grade dysplasia is recognized by markedly atypical cells with large pleomorphic nuclei with prominent nucleoli and a loss of polarity within the epithelium. The epithelium is delimited by a basement membrane and surrounded by inflammatory cells, mostly plasma cells with a few lymphocytes and pmn’s.

2. Invasive adenocarcinoma in association with high grade dysplasia in Barrett’s esophagus (high power):

Figure 2

Small round glandular structures with atypical nuclei are present in an infiltrative pattern in a reactive fibrous stroma. High grade dysplasia is in the epithelium enclosed by the basement membrane in the upper left corner.

The following narrative provides more information on the relationship between Esophageal Adenocarcinoma and GERD: Epidemiology of Adenocarcinoma

* Pathology slides of our patients were provided by Dr. James P. Kolton of Caritas Norwood Hospital, Norwood, MA.