Histology USMLE Step 1 Practice Question
A 58-year-old man with a 15-year history of gastroesophageal reflux disease presents for surveillance upper endoscopy. He reports persistent heartburn despite daily omeprazole therapy. Vital signs are stable. Endoscopy reveals a patch of salmon-colored, velvety mucosa extending 6 cm proximally from the gastroesophageal junction. Multiple biopsies are obtained from this area. Microscopic examination shows replacement of the normal stratified squamous epithelium with columnar epithelium containing goblet cells interspersed among mucus-secreting columnar cells. There is no evidence of nuclear enlargement, increased mitotic activity, or invasion. Which of the following best describes the histologic process occurring in the distal esophagus?
Answer choices
- AHyperplasia of basal cells with increased thickness of the stratum spinosum
- BIntestinal metaplasia with replacement of squamous epithelium by goblet cells and columnar mucosa
- CAcute inflammation with neutrophilic infiltration and erosion of epithelial surface
- DDysplasia with nuclear enlargement, increased nuclear-to-cytoplasmic ratio, and abnormal mitoses
- EBarrett esophagus with specialized columnar epithelium and intestinal metaplasiaCorrect answer
- FAdenocarcinoma with infiltrating mucin-secreting glands breaching the muscularis propria
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