WBR0567

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 56 year old male patient, known to be a heavy cigarette smoker and with a significant past medical history of type 2 diabetes mellitus, presents to the physician's office complaining of long-standing heartburn. Upon further questioning, the physician requests gastroscopy with biopsies in the proximal, mid, and distal thirds of the esophagus. A representative sample of the patient's esophageal biopsies is shown in the image below. Which of the following best describes the patient's condition? ]]
Answer A	AnswerA::Metaplasia
Answer A Explanation	AnswerAExp::Barrett's esophagus is a form of glandular metaplasia that transforms esophageal nonkeratinized stratified squamous epithelium into glandular columnar epithelium.
Answer B	AnswerB::Dysplasia
Answer B Explanation	AnswerBExp::Dysplasia is a reversible abnormal growth with loss of cellular shape, size, and orientation. Barrett's esophagus, per se, is not a form of dysplasia.
Answer C	AnswerC::Desmoplasia
Answer C Explanation	AnswerCExp::Desmoplasia is the formation of fibrous tissue in a neoplasm. Barrett's esophagus, per se, is not a form of desmoplasia
Answer D	AnswerD::Neoplasia
Answer D Explanation	AnswerDExp::Neoplasia is the irreversible clonal proliferation of cells with uncontrolled growth. Barrett's esophagus, per se, is not a form of neoplasia. However, it can lead to adenocarcinoma.
Answer E	AnswerE::Hyperplasia
Answer E Explanation	AnswerEExp::Hyperplasia is defined as the increase in the number of cells. Barrett's esophagus, per se, is not a form of hyperplasia.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Barrett's esophagus is a form of glandular metaplasia defined as the presence of columnar epithelium resembling that of the duodenum that lines the distal esophagus instead of the normal nonkeratinized stratified squamous epithelium. It is a common complication of long-standing gastroesophageal reflux disease (GERD). The definitive diagnosis of Barrett's esophagus is based on endoscopic biopsy of the distal esophagus. It is in fact of clinical concern due to its predisposition to adenocarcinoma of the esophagus, which justifies why close follow-up with subsequent endoscopies is indicated once the diagnosis is made. Treatment and prevention of dysplasia is by aggressive management of GERD and inhibition of the overproduction of gastric acids. Educational Objective: Barrett's esophagus is a metaplasia defined as the presence of columnar epithelium that lines the distal esophagus. References: Sjogren RW, Johnson LF. Barrett's esophagus: a review. Am J of Med. 1983; 74(2):313-321.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Barrett's, WBRKeyword::Barrett, WBRKeyword::Esophagus, WBRKeyword::Metaplasia, WBRKeyword::Hyperplasia, WBRKeyword::Dysplasia, WBRKeyword::Neoplasia, WBRKeyword::Desmoplasia, WBRKeyword::Glandular, WBRKeyword::Adenocarcinoma, WBRKeyword::GERD, WBRKeyword::Gastroesophageal, WBRKeyword::Reflux, WBRKeyword::Disease, WBRKeyword::Heartburn, WBRKeyword::Columnar, WBRKeyword::Epithelium
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