Definition/General
Introduction:
Esophageal inflammatory changes represent non-neoplastic reactive alterations in response to various injurious agents
Accurate cytological recognition prevents misdiagnosis of malignancy
Common causes include acid reflux, infections, medications, and radiation.
Origin:
Inflammatory changes result from mucosal injury and repair
Acid reflux is the most common cause
Infectious agents (viral, fungal, bacterial)
Chemical injury
Radiation effects
Medication-induced esophagitis.
Classification:
Classified by etiology and pattern
Reflux esophagitis
Infectious esophagitis
Eosinophilic esophagitis
Medication-induced esophagitis
Radiation esophagitis
Chemical esophagitis.
Epidemiology:
Very common condition
Reflux esophagitis affects 10-20% population
Male predominance in severe cases
Age-related increase
Associated with lifestyle factors.
Clinical Features
Presentation:
Heartburn (most common)
Chest pain
Dysphagia
Odynophagia
Regurgitation
Nocturnal symptoms
Chronic cough.
Symptoms:
Burning retrosternal pain
Difficulty swallowing
Painful swallowing
Food regurgitation
Water brash
Voice hoarseness.
Risk Factors:
Gastroesophageal reflux
Hiatal hernia
Obesity
Smoking
Alcohol consumption
Spicy foods
Medications (NSAIDs, bisphosphonates).
Screening:
Clinical assessment
Endoscopic evaluation
pH monitoring
Manometry studies
Imaging studies.
Master Esophageal Inflammatory Changes Pathology with RxDx
Access 100+ pathology videos and expert guidance with the RxDx app
Gross Description
Appearance:
Erythematous mucosa
Edematous appearance
Friable surface
Linear ulcerations
Erosions
White plaques (candidiasis).
Characteristics:
Loss of normal luster
Granular surface
Bleeding tendency
Thickened folds
Stricture formation (chronic).
Size Location:
Variable extent
Distal esophagus (reflux)
Entire length (systemic causes)
Patchy distribution
Circumferential involvement.
Multifocality:
Continuous involvement (reflux)
Patchy distribution (infectious)
Skip areas
Progressive changes.
Microscopic Description
Histological Features:
Reactive epithelial changes
Nuclear enlargement
Prominent nucleoli
Increased mitotic activity
Inflammatory cell infiltrate
Regenerative changes
Parakeratosis.
Cellular Characteristics:
Enlarged nuclei with smooth contours
Prominent nucleoli
Abundant cytoplasm
Well-preserved cell borders
Inflammatory cells (neutrophils, eosinophils, lymphocytes).
Architectural Patterns:
Epithelial hyperplasia
Basal cell hyperplasia
Papillomatosis
Balloon cell change
Mixed inflammatory infiltrate.
Grading Criteria:
Mild inflammation: Minimal epithelial changes
Moderate inflammation: Reactive atypia present
Severe inflammation: Marked reactive changes
Ulceration: Surface denudation.
Immunohistochemistry
Positive Markers:
CK5/6 (squamous epithelium)
p63 (basal cells)
Ki-67 (increased proliferation)
p53 (may be positive)
Inflammatory cell markers.
Negative Markers:
High-grade dysplasia markers
Malignancy markers
Viral inclusions (unless infectious)
Fungal stains (unless fungal).
Diagnostic Utility:
Confirms benign reactive nature
Excludes dysplasia
Identifies infectious agents
Proliferation assessment.
Molecular Subtypes:
Reflux-associated changes
Infectious patterns
Eosinophilic pattern
Drug-induced changes.
Molecular/Genetic
Genetic Mutations:
No specific mutations
p53 alterations (severe inflammation)
DNA damage markers
Inflammatory pathway activation.
Molecular Markers:
Inflammatory cytokines
COX-2 upregulation
NF-κB activation
Growth factors
Oxidative stress markers.
Prognostic Significance:
Usually reversible
Chronic inflammation may predispose to malignancy
Barrett esophagus development
Stricture formation.
Therapeutic Targets:
Proton pump inhibitors
H2 receptor blockers
Antifungal agents
Antiviral agents
Anti-inflammatory agents.
Differential Diagnosis
Similar Entities:
Dysplasia
Squamous cell carcinoma
Viral cytopathic effects
Radiation changes
Chemical injury.
Distinguishing Features:
Inflammatory: Smooth nuclear contours
Inflammatory: Preserved architecture
Dysplasia: Architectural distortion
Carcinoma: Invasive features
Viral: Inclusion bodies.
Diagnostic Challenges:
Severe reactive atypia
Distinguishing from dysplasia
Infectious agent identification
Medication effects.
Rare Variants:
Eosinophilic esophagitis
Lymphocytic esophagitis
Crohn disease
Graft-versus-host disease.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Esophageal cytology, [technique used], adequate for evaluation
Diagnosis
Inflammatory changes - [mild/moderate/severe] esophagitis
Inflammatory Pattern
Inflammatory pattern: [neutrophilic/eosinophilic/lymphocytic/mixed]
Reactive Changes
Reactive epithelial changes: [nuclear enlargement] and [nucleolar prominence]
Infectious Organisms
Infectious organisms: [present/absent], [organism type if present]
Nuclear Features
Nuclear features: [reactive changes], no dysplasia
Severity Assessment
Severity: [mild/moderate/severe] inflammatory changes
Clinical Correlation
Clinical correlation with [symptoms] and [risk factors] recommended
Final Diagnosis
Esophageal cytology: Inflammatory changes/esophagitis