Much ado about very little (lamina propria)?

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Presentation transcript:

Much ado about very little (lamina propria)? Elizabeth Montgomery, MD Gastrointestinal Endoscopy Volume 75, Issue 1, Pages 19-22 (January 2012) DOI: 10.1016/j.gie.2011.07.041 Copyright © 2012 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 A, In this EMR section, there is squamous mucosa at the right and an area of Barrett's mucosa at the top of the sample. At the left, there is a zone of buried Barrett's mucosa; both Barrett's foci demonstrate a duplicated muscularis mucosae. Note that the lamina propria (the supporting tissue around the glands) in the area of the Barrett's mucosa is cellular, whereas the lamina propria beneath the pure squamous epithelium has little cellularity. When such a focus is biopsied, negligible lamina propria tissue is grasped, and little lamina propria tissue appears on small biopsy samples (H&E, orig. mag. ×20). B, Note the higher magnification of the zone at the left part of Figure 1A at the interface between the buried Barrett's mucosa and squamous mucosa. Some of the buried glands are intimately associated with the squamous epithelium and embedded in cellular stroma that would be biopsied as a unit (H&E, orig. mag. ×10). C, This is a mucosal biopsy sample showing buried nondysplastic Barrett's mucosa. Again, note the abundant lamina propria (H&E, orig. mag. ×20). D, Another mucosal biopsy detecting buried high-grade dysplasia. There is abundant lamina propria, and the glands are closely apposed to the squamous mucosa and thus were readily sampled (H&E, orig. mag. ×20). Gastrointestinal Endoscopy 2012 75, 19-22DOI: (10.1016/j.gie.2011.07.041) Copyright © 2012 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 A, Confocal laser endomicroscopy would detect the buried dysplastic glands, because they are about 250 μm below the surface (H&E, orig. mag. ×20). B, Only the squamous component would be apparent, but the reactive squamous changes might prompt a biopsy. Note that the buried lamina propria neoplasia has a dense supporting lamina propria that would be readily grasped by biopsy forceps in addition to the overlying squamous epithelium (H&E, orig. mag. ×20). Gastrointestinal Endoscopy 2012 75, 19-22DOI: (10.1016/j.gie.2011.07.041) Copyright © 2012 American Society for Gastrointestinal Endoscopy Terms and Conditions