Issues with Esophageal Biopsies: A Focus on Barrett’s Esophagus (Video)

In this video, John Goldblum, MD, Chair of the Department of Pathology at Cleveland Clinic and staff pathologist of the Soft Tissue and Bone Pathology service, discusses several cases of esophageal biopsies with a focus on Barrett’s esophagus. He also shares his thoughts on the best stains for goblet cells, when a pathologist should give descriptive diagnoses in the absence of endoscopic information, and why he starts at low magnification when reviewing esophageal biopsies.

The first case is a 27-year-old male who presented with dysphasia refractory to proton pump inhibitors. His esophageal biopsies appear partially blue, which Dr. Goldblum identifies as indicative of inflammation. Pink in esophageal biopsies indicates a lack of inflammation because of all the glycogen in the esophageal squamous mucosa.

Dr. Goldblum switches to higher magnification to show the inflammatory cells within the esophageal mucosa. All are eosinophils with essentially no neutrophils or lymphocytes present. He then looks for organization of the eosinophils within the squamous mucosa, which does not appear to be present. Some of the eosinophils are degranulated which can make them difficult to count. To count them, he recommends viewing the densest area and counting in that location. Thus, the slides appear to show an eosinophil-rich esophagitis, with the biopsies from the distal esophagus showing prominent intraepithelial eosinophils. Dr. Goldblum explains that these characteristics are indicative of but not pathognomonic for eosinophilic esophagitis, the diagnosis of which would require clinical and endoscopic findings as well. Watch the video to learn more.

Cleveland Clinic Laboratories’ Pathology Insights video series features important cases, methods, and practices that are personally presented by our staff pathologists.

These short videos break down information about interesting pathology cases to better inform doctors, laboratory staff, patients or anyone interested in the field of pathology.