A 52-year-old man with long-standing gastroesophageal reflux undergoes endoscopy, which shows tongues of salmon-colored mucosa in the distal esophagus. Biopsy shows replacement of the normal squamous epithelium by columnar epithelium with goblet cells. This change is best classified as:
- A Metaplasia, specifically intestinal columnar metaplasia ✓
- B Hyperplasia of the esophageal squamous epithelium
- C Dysplasia arising de novo in the squamous mucosa
- D Hypertrophy of residual basal squamous cells
Correct answer: A. Metaplasia, specifically intestinal columnar metaplasia
Explanation
Barrett esophagus is a classic adaptive response in which chronic acid exposure causes one differentiated adult cell type (squamous) to be replaced by another better able to withstand the environment (intestinal columnar with goblet cells), defining metaplasia. Hyperplasia and hypertrophy increase cell number and size respectively without changing cell type. Dysplasia implies disordered architecture and cytologic atypia; while Barrett metaplasia predisposes to dysplasia and adenocarcinoma, the biopsy finding described here is metaplasia itself.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.