... When goblet cells are abundant and intestinal metaplasia is complete without any pyloric or oxyntic glands, the mucosa is known as "specialized" mucosa.... 

Barrett esophagus or esophagitis can be diagnosed by pathologic examination of esophageal mucosal biopsy without clinical input. The key histopathology is the presence of intestinal metaplasia in the form of goblet cells. When goblet cells are abundant and intestinal metaplasia is complete without any pyloric or oxyntic glands, the mucosa is known as "specialized" mucosa. It is important to know that mucinous glands exist normally under stratified squamous esophageal mucosa and the lining epithelia of these glands may contain prominent cytoplasmic mucinous vacuoles that look like the mucinous vacuoles in true goblet cells. These are known as pseudo-goblet cells and not true goblet cells. They may extend upward to appear on the mucosal surface occasionally. These pseudo-goblet cells usually exists in continuous rows without interruption. In contrast, true goblet cells usuallu occurs in isolated form between non-goblet mucinous cells. Alcian blue/periodic acid-Sciff (AB/PAS) stain the cytoplasmic mucin blue in mucinous pseudo-goblet cells, but the staining is not as intense as in true goblet cells. The degree of inflammation in Barrett esophagus varies from non-existent to marked. When marked, cytologic atypia may mimic dysplasia.

Barrett 食管或食管炎能够不依赖于临床信息而靠食管黏膜活检病理学检查单独作出诊断。关键的组织病理学特征是“含有杯状细胞的肠上皮化生”的出现。当杯状细胞较多且肠上皮化生为完全性（无幽门腺和胃腺）时，黏膜即为特异化（specialized）黏膜。黏液腺体正常位于食管黏膜复层鳞状上皮下方，并且这些腺体的被覆上皮可以含有明显的细胞质内黏液空泡，它看上去非常类似杯状细胞内的黏液空泡，了解这些特点很重要。因为这并不是真的杯状细胞，而是所谓的假杯状细胞。 他们偶尔可以向上延伸出现在黏膜表面。这些假杯状细胞常连续呈排分布，中间没有间隔。相反，真杯状细胞常在非杯状细胞间孤立存在。 AB/PAS染色显示假杯状细胞的细胞质呈现蓝色，但没有真杯状细胞深染。 Barrett食管中，炎症程度可以从没有到明显。炎症明显时，反应性的细胞非典型性（atypia）可类似于细胞异型性（dysplasia）改变。

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