TY - JOUR
T1 - A renewed insight into Barrett's esophagus
T2 - Comparative histopathological analysis of esophageal columnar metaplasia
AU - Nemeth, I. B.
AU - Rosztoczy, A.
AU - Izbeki, F.
AU - Roka, R.
AU - Gecse, K.
AU - Sukosd, F.
AU - Nyari, T.
AU - Wittmann, T.
AU - Tiszlavicz, L.
N1 - Copyright: Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2012/7
Y1 - 2012/7
N2 - Specialized intestinal metaplasia (SIM) is considered as a premalignant condition of the esophagus, but other types of esophageal metaplasia are commonly neglected. A standardized histopathological analysis was focused not only on SIM but also on the presence of metaplastic processes typical of additional glands. A morphological study using standardized histopathological tests was carried out between 2004 and 2007, with biopsies taken from esophageal mucosa of 826 consecutive patients. Mean age and male : female ratio of patients were 55.6 ± 14.7 and 1.1 : 1, respectively. Only 4.1% (n= 34) of all cases proved to have SIM. The remainder of the cases (n= 615; 74.4%) contained cardiac-fundic mucosa without SIM. Some samples exhibited superficial mucous glands, pancreatic acinar metaplasia (PAM), and ciliated metaplasia accounting for 24% (n= 198), 14.9% (n= 123), and 0.2% (n= 2), respectively. SIM was colocalized with superficial mucous glands (103/198 superficial mucous gland cases; P < 0.001). Low-grade dysplasia (n= 51; 6.2%) and high-grade dysplasia (n= 9; 1.1%) were found mainly in SIM (37/51; 9/9; P= 0.071) with male preponderance (3 : 1 at low-grade and 2 : 1 at high-grade dysplasia). PAM was found mainly in cases without dysplasia (103 of 123 pancreatic metaplasias; P < 0.001). SIM alone in the esophagus is rare, and its frequent association with cardiac mucosa-type metaplasia testifies to transition of mucinous-goblet cell through pseudogoblet cells. PAM rather indicates absence of dysplasia, but superficial mucous glands predicts that SIM follows dysplasia.
AB - Specialized intestinal metaplasia (SIM) is considered as a premalignant condition of the esophagus, but other types of esophageal metaplasia are commonly neglected. A standardized histopathological analysis was focused not only on SIM but also on the presence of metaplastic processes typical of additional glands. A morphological study using standardized histopathological tests was carried out between 2004 and 2007, with biopsies taken from esophageal mucosa of 826 consecutive patients. Mean age and male : female ratio of patients were 55.6 ± 14.7 and 1.1 : 1, respectively. Only 4.1% (n= 34) of all cases proved to have SIM. The remainder of the cases (n= 615; 74.4%) contained cardiac-fundic mucosa without SIM. Some samples exhibited superficial mucous glands, pancreatic acinar metaplasia (PAM), and ciliated metaplasia accounting for 24% (n= 198), 14.9% (n= 123), and 0.2% (n= 2), respectively. SIM was colocalized with superficial mucous glands (103/198 superficial mucous gland cases; P < 0.001). Low-grade dysplasia (n= 51; 6.2%) and high-grade dysplasia (n= 9; 1.1%) were found mainly in SIM (37/51; 9/9; P= 0.071) with male preponderance (3 : 1 at low-grade and 2 : 1 at high-grade dysplasia). PAM was found mainly in cases without dysplasia (103 of 123 pancreatic metaplasias; P < 0.001). SIM alone in the esophagus is rare, and its frequent association with cardiac mucosa-type metaplasia testifies to transition of mucinous-goblet cell through pseudogoblet cells. PAM rather indicates absence of dysplasia, but superficial mucous glands predicts that SIM follows dysplasia.
KW - Barrett's esophagus
KW - Pancreatic acinar cell metaplasia
KW - Specialized intestinal metaplasia
KW - Superficial mucous gland
UR - http://www.scopus.com/inward/record.url?scp=84863471327&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/j.1442-2050.2011.01270.x
DO - https://doi.org/10.1111/j.1442-2050.2011.01270.x
M3 - Article
C2 - 22035281
SN - 1120-8694
VL - 25
SP - 395
EP - 402
JO - Diseases of the Esophagus
JF - Diseases of the Esophagus
IS - 5
ER -