Metaplasia is a reversible adaptive change. Barrett's oesophagus represents columnar metaplasia of squamous epithelium due to acid reflux. Which type of columnar epithelium must be present histologically to define Barrett's oesophagus and carry cancer risk?
- A Gastric fundic-type mucosa with parietal and chief cells
- B Specialised intestinal metaplasia with goblet cells ✓
- C Gastric cardia-type mucosa without goblet cells
- D Pancreatic acinar metaplasia
Correct answer: B. Specialised intestinal metaplasia with goblet cells
Explanation
Barrett's oesophagus is defined as the replacement of distal oesophageal squamous epithelium by specialised intestinal metaplasia characterised by the presence of goblet cells on biopsy. This intestinal-type epithelium (specifically with goblet cells positive for Alcian blue at pH 2.5) carries a 30–40 times elevated risk of developing oesophageal adenocarcinoma through a metaplasia → dysplasia → adenocarcinoma sequence. Gastric cardia-type columnar mucosa without goblet cells does not confer the same malignant risk.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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