Diseases of the esophagus – The cytological diagnosis of diseases of the alimentary canal
The wall of the esophagus It consists of three layers: mucous, muscular and adventitia. Surface esophageal mucosa covered by stratified squamous epithelium, which elderly people can Stratum. Some of these cells are constantly exfoliate, They contain large amounts of grain keritogmalina, arranged around the core. IN sprout basal layer many cells with mitotic figures. Epithelial It located on the basal membrane.
Under the epithelium is lamina propria, which is loose connective tissue, consisting of collagen and elastin fibers and clusters of lymphocytes.
The submucosa of the upper and lower thirds of the esophagus have cancer, similar to the cardiac glands of the stomach, and cancer, producing mucus. These are simple branched tubular glands, lined with a single layer of cuboidal or columnar epithelium with a granular cytoplasm. In adenomere found parietal cells and cylindrical. The locations of the cardiac glands of the esophagus most often arise diverticula, cyst, ulcers and tumors.
For cytological diagnosis of esophageal cancer investigated prints from a mucosal surface, washings esophagus, aspirates, punctate.
The washings esophagus obtained by double gastroduodenal probe. The probe with a balloon is introduced slightly below the expected swelling and filled with air to close the lumen of the esophagus, and through a second tube heat input isotonic sodium chloride solution and immediately sucked off his, collecting in a separate bowl. The precipitate was centrifuged and the wash water used for preparing cytological specimens. They are also prepared from prints or flushing probe, vomit and learn the native and dyed. Sometimes they make prints of tampons, fixed on probe. In cytological preparations can detect cells of stratified squamous epithelium, elements inflammation, and malignantly changed cells.
In normal esophageal mucosa stratified squamous epithelium cells are found in cytological preparations in small quantities. Usually are cells of the surface layer with a small pyknotic nucleus, less often younger - intermediate with a larger core and blistered mesh pattern of chromatin. When inflammation or injury can be observed a large number of squamous cells, often in the form of layers or aggregations.
Elements inflammation found in the esophagitis and esophageal ulcers. Esophagitis can occur due to damage to the mucous membrane of the rough hot food, foreign bodies, etc.. Ulcers of the esophagus nonneoplastic origin are rare. The most frequently detected peptic ulcers of the lower third of the esophagus. At the same time the bulk of the cells in cytological preparations comprise leukocytes, There are also plasma cells, polynuclear giant cells of chronic inflammation and histiocytes.
A large number of dead cells of the squamous epithelium in the form of flakes is observed at leukoplakia. Inflammation, ulcer, leukoplakia, dysplasia and other lesions of the mucous membrane of the esophagus can cause cancer.
Differentiation of precancerous epithelial changes (dysplasia) and tumor cells is important in the diagnosis and treatment of esophageal cancer. To detect dysplasia need to consider a number of features of the structure as a nucleus, and cytoplasm, nuclear-cytoplasmic ratio, the location of the epithelial cells, the presence and amount of connective tissue cells.
Characteristic feature of epithelial dysplasia of the esophagus are signs of keratinization of the cytoplasm in the form of small or large complexes keratogialinovyh (keratin calf) of different size and color intensity, located mainly around the nucleus. Such cells called keratinocytes. When leukoplakia cells have degenerative changes signs keratosic.
When mild dysplasia (Grade I, temnokletochny option) changes relate to the basal layer. Thus cells of small size, round or fusiform. Cores of enlarged, hyperchromatic, nuclear chromatin condensed mainly near karyotheca (nuclear envelope), the contours of which are not entirely smooth, The cytoplasm has a narrow rim, revealed cytoplasmic processes. The nuclear-cytoplasmic ratio is shifted toward the core. The cells are arranged in groups and formations. Temnokletochnaya dysplasia often develops along with leukoplakia.
In moderate dysplasia (Grade II) says the combination of dysplasia cells of the basal layer and more mature elements with signs of dyskeratosis. Along with the described dark cells, , and larger light, with a large nucleus and a narrow pale cytoplasm, containing basophilic keratogielin.
With clear-dysplasia (Grade III) large cells. Their cytoplasm has smooth contours, polymorphic light nuclei with large or centrally located premarginalnym granular chromatin. In the cytoplasm there are grains keratohyalin, sometimes fills the entire cell; nuclear-cytoplasmic ratio is increased in the direction of the core.
Dysplasia stratified squamous epithelium of the esophagus usually develops on the background of inflammation or hyperplasia. Besides, dysplasia observed in the field of tumor in the presence of an existing cancer.
