Question:medium

The accompanying histology slide of esophageal mucosa shows the lower esophageal lining replaced by columnar (intestinal-type) epithelium with goblet cells in place of the normal stratified squamous epithelium. Which condition does this represent?

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Look for goblet cells (intestinal metaplasia) in the lower esophageal mucosa.
Updated On: Jun 25, 2026
  • Barrett's esophagus
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Low grade dysplasia
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The Correct Option is A

Solution and Explanation

The key to this slide is the type of epithelium covering the distal esophageal mucosa. Normally this is stratified squamous; here it has been converted into a columnar lining studded with $goblet$ $cells$.

This conversion of one mature differentiated epithelium into another is termed metaplasia. In the esophagus, chronic acid and bile reflux (GERD) drives the squamous-to-columnar (intestinal) metaplasia we call Barrett's esophagus. The defining feature demanded by pathologists is specialised intestinal metaplasia - columnar cells with interspersed goblet cells.

Distinguishing it from the distractors:
$\bullet$ Squamous cell carcinoma to malignant squamous nests, keratin pearls, intercellular bridges.
$\bullet$ Adenocarcinoma to frankly malignant infiltrating glands, often arising on a background of Barrett's.
$\bullet$ Low-grade dysplasia to superimposed nuclear crowding/hyperchromasia on Barrett mucosa, but the bland goblet-cell metaplasia shown is the underlying lesion, not dysplasia.

Because the slide shows uncomplicated goblet-cell columnar metaplasia, the answer is:
\[\boxed{\text{Barrett's esophagus}}\]
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