Dysplasia in Barrett’s may be classified as indefinite, low grade or high grade.
I looked at an interesting case today which showed nuclear atypia with enlarged overlapping nuclei, mitoses and loss of surface maturation. But it was clearly focal and overlying an area of granulation tissue, there were also associated scattered neutrophil polymorphs and therefore the appearances are indefinite for dysplasia and probably represent reactive changes.
Additionally in one area there was evidence of tufting and also in areas the nuclear polarity appeared still to be maintained.
Features that help in differentiating dysplasia from reactive/regenerative change:
- Nuclear polarity – The long axis of the nuclei are perpendicular to the basement membrane.
- Surface maturation
- Dysplasia often shows an abrupt transition
- Evidence of inflammation
Surgical Pathology of the GI tract, Liver, Biliary tract and Pancreas. Odze & Goldblum. 2nd Ed.