Eosinófilos intraepiteliales ≥15/ HPF Microabscesos eosinofílicos (42%) Eosinófilos tapizando la superficie Eosinófilos peripapilares (estadio incipiente) Signos de degranulación eosinofílica Descamación epitelial Hiperplasia de capa basal Elongación de papilas Edema intercelular Fibrosis /esclerosis de lámina propia (>50%) Aumento de mastocitos y degranulacion Linfocitos T CD8+ y celulas B
EoE
Degranulación Espacios intercelulares
Infiltración eosinofílica Expansión de la membrana basal
Exudado
More than just counting eosinophils: proximal oesophageal involvement and subepithelial sclerosis are major diagnostic criteria for eosinophilic oesophagitis. de Boer WB, Leslie C. Raftopoulous S. J. Clin. Pathol. 2010 63(7): 644-647
Fibrosis de lamina propia
Esophageal subepithelial fibrosis and hialinization are features of eosinophilic esophagitis. Li - Kim - Moy JP (2011), J Pediatr Gastroenterol Nutr 52(2):147 -53. -
27 EoE y 24 GERD Fibrosis subepitelial: EoE (uniforme, hialina)……………………………………………….89% GERD (parcheada asociada a tejido linfoide)…………….37.5% P>0.001
La fibrosis subepitelial en la EoE se asocia a una mayor edad y mas tiempo de sintomatologia.
Kagalwalla et al. J. Allergy Clin Immunol, (2012) Serie (680) EoE: 18 Indet. EoE: 15 GERD:7 Normal:21
HScore ETM (0-6) Coexpression VimentinCitokeratin
Caracterización del infiltrado celular en EoE
Tryptase staining of mast cells may differentiate eosinophilic esophagitis from gastroesophageal reflux disease. Dellon ES.et al (2011) Am. J. Gastroenterol. 106(2):264-271
Mast cells infiltrate the esophageal smototh muscle in patients with eosinophilic esophagitis, express TGF-β1, and increase esophageal smooth muscle contraction. Aceves SS. Et al. (2010) J. Allergy Clin. Immunol.126 (6): 1205-7
Lucendo et al., 2007 Am J Surg Pathol
Eosinophilic esophagitis: Updated consensus recommendations for children and adults. The Journal of Allergy and Clinical Immunology 121(1): 3-20, 2011
¾No change in threshold number of 15 eosinophils/hpf. (Since the 2007 CR, no studies have identified a clear “lower limit of esophageal eosinophilia” or threshold number that would define EoE or have identified other histologic features or pattern of disease distribution that are pathognomonic of EoE.)
¾No change in the use of ‘hpf’ as the unit of measurement for eosinophilia. (No studies have yet determined a standardized size of an hpf, and this might be practically unachievable. This issue is problematic because the size of an hpf can alter the reported number of eosinophils per hpf.)
Saffari H, Peterson KA, Fang JC.
J. Allergy Clin. Immunol. 2012
Five 2 mm biopsy specimen represent less than 0.7% of the 20-25 cm. long esophageal mucosa !!
17 sections 400X= 0.26 mm2
Blue: 3eos /HPF or less Green: 4‐14 eos/HPF Pink: 15‐19 eos/HPF Red: = or>20 eos/HPF
Valoración óptima de la biopsia esofágica: Informe AP ¾ ¾
¾
.
Un muestro biópsico (4-5) de esófago proximal medio y distal Cuantificación del nº de eosinófilos/campo de gran aumento (x400) (hot spot area : mayor densidad de eosinófilos) Descripción de otras caracteristicas morfológicas : - microabscesos eosinofilicos - degranulación de eosinófilos (granulos extracelulares) - hiperplasia de celulas basales - espacios intercelulares dilatados - si fibrosis de lámina propia Hay algunos casos con fuerte evidencia clinica de EoE con