A 65-year-old man with a 25-year history of gastroesophageal reflux disease undergoes surveillance endoscopy. Biopsies from 3 cm above the gastroesophageal junction show replacement of the normal stratified squamous epithelium by columnar epithelium with goblet cells. Which of the following best explains why this lesion is clinically significant?
- A It is a premalignant lesion with significantly increased risk of esophageal adenocarcinoma ✓
- B It represents metaplastic change associated with a markedly increased risk of squamous cell carcinoma
- C It is a benign adaptive response that does not increase cancer risk
- D It indicates active H. pylori infection and increases risk of gastric cancer
Correct answer: A. It is a premalignant lesion with significantly increased risk of esophageal adenocarcinoma
Explanation
The description is Barrett esophagus — specialized intestinal metaplasia of the esophageal squamous epithelium in response to chronic acid exposure, defined by the presence of goblet cells (intestinal-type columnar epithelium). Barrett esophagus is a well-established premalignant condition conferring a 30–40 fold increased risk of esophageal adenocarcinoma through a metaplasia-dysplasia-carcinoma sequence. It is not associated with squamous cell carcinoma; H. pylori causes gastric intestinal metaplasia in the stomach.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.