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Low vs. High Grade Dysplasia- How do I tell the difference?

Low-Grade Dysplasia

  • Slightly crowded glands


  • "Upside down" goblet cells

  • REDUCED surface maturation- Larger, hyperchromatic nuclei at surface with loss of mucin

  • MAINTAINED NUCLEAR POLARITY (long axes of nuclei are perpendicular to basement membrane- still "pencil-like" or an orderly "picket fence")

  • MINIMAL nuclear membrane irregularity

  • Inflammation typically minimal


High-Grade Dysplasia

  • Sometimes presents as nodule visible at endoscopy

  • Some cases show crowded glands but often architecture is similar to that of nondysplastic Barrett mucosa

  • LOSS OF surface maturation (hyperchromatic nuclei extend all the way to the surface instead of remaining confined to base/crypt)

  • LOSS OF NUCLEAR POLARITY = nuclei have lost organized relationship to basement membrane


  • Nucleoli NOT prominent (prominent nucleoli are seen in reactive changes or indicate an invasive component is probably close by)

  • Occasional cases infiltrated by neutrophils


These photos were taken using, an awesome resource for learning from any of the excellent cases/ virtual slides on there.

PS: I am in no way affiliated with them, but I sure will promote them to anyone in pathology I meet.

I sure do love me some good ol' digital pathology (said in my most southern twang voice)!


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