WBR0567

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 56-year-old obese Caucasian man, with a past medical history significant for well-controlled type 2 diabetes mellitus, presents to the physician's office for long-standing heartburn. The patient reports he is a heavy cigarette smoker and drinks 1-2 beers each day. Following history-taking and physical examination, the physician requests a 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 this patient's condition? ]]
Answer A	AnswerA::Metaplasia
Answer A Explanation	AnswerAExp::Barrett's esophagus is a form of glandular metaplasia whereby normal esophageal nonkeratinized stratified squamous epithelium is replaced by 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. Nonetheless, long-standing Barrett's esophagus may result in low grade dysplasia, then high grade dysplasia, and finally esophageal adenocarcinoma.]]
Answer C	AnswerC::Desmoplasia
Answer C Explanation	AnswerCExp::Desmoplasia is the formation of fibrous or connective tissue usually secondary to a neoplasm. Barrett's esophagus is not a form of desmoplasia. Several cutaneous and visceral cancers may be associated with desmoplasia..
Answer D	AnswerD::Neoplasia
Answer D Explanation	AnswerDExp::Neoplasia is the irreversible clonal proliferation of cells with uncontrolled growth. Barrett's esophagus is not a form of neoplasia. However, it can result in adenocarcinoma.
Answer E	AnswerE::Hyperplasia
Answer E Explanation	AnswerEExp::Hyperplasia is defined as tissue growth due to the increase in the number of cells. Barrett's esophagus is not a form of hyperplasia. An example of hyperplasia is benign prostate hyperplasia (BPH) among men older than 50 years of age.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Barrett's esophagus is a form of glandular metaplasia, defined as loss of the normal non-keratinized stratified squamous epithelium of the distal esophagus. Instead, the epithelium is replaced by abnormal glandular columnar epithelium which resembles that of the duodenum. Barrett's esophagus is a premalignant lesion among the majority of patients with esophageal adenocarcinoma. The definitive diagnosis of Barrett's esophagus is based on endoscopic biopsy of the distal esophagus. Barrett's esophagus is a clinical concern due to its predisposition to adenocarcinoma of the esophagus. Barrett's esophagus is a common complication of long-standing gastroesophageal reflux disease (GERD). In addition to GERD and GERD symptoms, the most important risk factors for the development of Barrett's esophagus include obesity, advanced age, male sex, and white race. Patients with Barrett's esophagus are approximately 30-40 times more likely to develop esophageal adenocarcinoma compared to patients with no Barrett's esophagus, which justifies why close follow-up and multiple endoscopies to screen for dysplasia and adenocarcinoma are indicated once the diagnosis is made. Treatment of Barrett's esophagus and prevention of dysplasia are generally by aggressive management of GERD using acid-suppressive therapy. Educational Objective: Barrett's esophagus is a premalignant lesion of the distal esophagus. It is a form of metaplasia, whereby normal esophageal nonkeratinized stratified squamous epithelium is replaced by glandular columnar epithelium. References: Sharma P. Barrett's esophagus. N Engl J Med. 2009;361:2548-56. Sjogren RW, Johnson LF. Barrett's esophagus: a review. Am J of Med. 1983; 74(2):313-321. First Aid 2014 page 350]]
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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