Interactive Case Study Companion

Ulcerating tumor
Heaped-up margins
Squamous mucosa
Gastroesophageal junction

9 - Esophagus, advanced adenocarcinoma in Barrett esophagus - Gross, mucosal surface  
This esophagogastrectomy specimen shows a large, irregular, ulcerating tumor with heaped-up margins at the gastroesophageal junction. Note the pink, heaped-up metaplastic columnar epithelium and the adjacent white squamous mucosa. Endoscopic biopsies for the evaluation of specialized columnar-type epithelium or associated dysplasia should be taken from the interface between white squamous mucosa and the pink, heaped-up Barrett epithelium. Most adenocarcinomas arising in a Barrett esophagus occur in white males older than 40 years of age. Patients usually present because of dysphagia, weight loss, bleeding, chest pain, and vomiting.  
What do heaped-up margins indicate? (Review concepts of Neoplasia.)


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