Email this article Clinical and morphological analysis of dysplasia in Barrett's esophagus and columnar-lined esophagus
- Authors: Mikhaleva L.M.1,2, Voytkovskaya K.S.2, Fedorov E.D.2,3, Birukov A.E.1,2, Gracheva N.A.2, Shegoleva N.N.2, Chigrai L.V.2, Shidii-Zakrua A.V.3
-
Affiliations:
- Research Institute of Human Morphology
- City Clinical Hospital No. 31 of Moscow Healthcare Department
- Pirogov Russian National Research Medical University (RNRMU)
- Issue: Vol 48, No 2 (2020)
- Pages: 94-101
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/1253
- DOI: https://doi.org/10.18786/2072-0505-2020-48-011
- ID: 1253
Cite item
Full Text
Abstract
Background: Barrett's esophagus (BE) is a precan-cerous disease of the esophagus. The risk of adenocarcinoma in BE patients increases with the extension of segment length and with the presence of dysplasia. Columnar-lined esophagus (CLE) devoid goblet cells is also associated with dysplasia and adenocarcinoma, however, with a lower risk. Aim: To perform clinical and morphological analysis of patients with BE with goblet cells and CLE devoid goblet cells on the presence or absence of dysplasia. Materials and methods: This prospective clinical morphological study included 78 patients with columnar-lined esophagus at EGDS, among them 20 patients with a long segment, 58 patients with a short segment. Biopsy specimens from the CLE area of the distal part of the esophagus were stained by hematoxylin and eosin and standard PAS-reaction with Alcian blue. Histological examination showed BE with goblet cells in 49 patients and CLE devoid goblet cells in 29 patients. In those with BE, the morphometric analysis of the goblet cells density was performed and the number of the affected crypts was counted in dysplastic fragments. Results: In the short segment group, the male to female ratio was ~ 1:1.1, and CLE devoid goblet cells was found in 53% of cases (27/58 patients), and BE with goblet cells in 57% of cases (31/58 patients). In the long segment group, the male to female ratio was ~ 2.3:1, along with predominance of BE with goblet cells cases (18/20 patients, 90%) and high density of goblet cells (11/18 patients, 61%). The rates of goblet cells detection increased with the extension of the segment length (p < 0.05). The relative goblet cells density in the patients with the long BE segment was also significantly higher than in the short segment group (p < 0.001). Advanced inflammatory infiltration was found in 22 of 58 (38%) cases with the short segment and in 13 of 20 patients with the long one (65%, p = 0.012). The rates of erosion in the long segment group were 1.62-fold higher and ulcerations 3.87-fold higher (p = 0.014). Esophageal dysplasia was identified in 10 of 20 cases (50%) with the long segment and in 2 of 58 cases (3.4%) with the short segment. In 10 of 12 cases (83.3%) dysplasia was multifocal and involved from 2 to 10 crypts (in total, up to 25 crypts). Conclusion: The long segment of metaplasia was associated with higher rates of active chronic esophagitis, higher presence of goblet cells and their higher density. Dysplasia was found in 10 patients with three and more risk factors of progression (male gender, long segment, hiatal hernia, etc.). In most cases, the biopsy samples showed multiple foci of dysplasia.
About the authors
L. M. Mikhaleva
Research Institute of Human Morphology;City Clinical Hospital No. 31 of Moscow Healthcare Department
Author for correspondence.
Email: mikhalevalm@yandex.ru
ORCID iD: 0000-0003-2052-914X
Liudmila M. Mikhaleva - MD, PhD, Professor, Director,Research Institute of Human Morphology; Head of Pathology Department, City Clinical Hospital No. 31 of Moscow Healthcare Department.
3 Tsyurupy ul., Moscow, 117418; 42 Lobachevskogo ul., Moscow, 119415.
Tel.: +7 (903) 621 44 57.
РоссияK. S. Voytkovskaya
City Clinical Hospital No. 31 of Moscow Healthcare Department
Email: fake@neicon.ru
ORCID iD: 0000-0001-8083-9428
Ksenia S. Voytkovskaya - MD, Pathologist, Pathology Department.
42 Lobachevskogo ul., Moscow, 119415.
РоссияE. D. Fedorov
City Clinical Hospital No. 31 of Moscow Healthcare Department;Pirogov Russian National Research Medical University (RNRMU)
Email: fake@neicon.ru
ORCID iD: 0000-0002-6036-7061
Evgeny D. Fedorov - MD, PhD, Professor, Clinical Director of the Department of Endoscopy and Endoscopic Surgery, City Clinical Hospital No. 31 of Moscow Healthcare Department; Chief Research Fellow, Scientific and Research Laboratory of Surgical Gastroenterology and Endoscopy, RNRMU.
42 Lobachevskogo ul., Moscow, 119415; 1 Ostrovityanova ul., Moscow, 117997.
РоссияA. E. Birukov
Research Institute of Human Morphology;City Clinical Hospital No. 31 of Moscow Healthcare Department
Email: fake@neicon.ru
ORCID iD: 0000-0001-9700-3352
Andrei E. Birukov - MD, PhD, Senior Research Fellow, Laboratory of Clinical Morphology,Research Institute of Human Morphology; Pathologist, Pathology Department,City Clinical Hospital No. 31 of Moscow Healthcare Department.
3 Tsyurupy ul., Moscow, 117418; 42 Lobachevskogo ul., Moscow, 119415.
РоссияN. A. Gracheva
City Clinical Hospital No. 31 of Moscow Healthcare Department
Email: fake@neicon.ru
ORCID iD: 0000-0001-7286-6629
Natalia A. Gracheva - MD, PhD, Pathologist, Pathology Department.
42 Lobachevskogo ul., Moscow, 119415.
РоссияN. N. Shegoleva
City Clinical Hospital No. 31 of Moscow Healthcare Department
Email: fake@neicon.ru
Natal'ya N. Shegoleva - MD, PhD, Pathologist, Pathology Department.
42 Lobachevskogo ul., Moscow, 119415.
РоссияL. V. Chigrai
City Clinical Hospital No. 31 of Moscow Healthcare Department
Email: fake@neicon.ru
Lyudmila V. Chigrai - MD, Pathologist, Pathology Department.
42 Lobachevskogo ul., Moscow, 119415.
РоссияA. V. Shidii-Zakrua
Pirogov Russian National Research Medical University (RNRMU)
Email: fake@neicon.ru
ORCID iD: 0000-0001-9067-2641
Albina V. Shidii-Zakrua - MD, Postgraduate Student, Faculty of General Medicine, Chair of Hospital Surgery No. 2.
1 Ostrovityanova ul., Moscow, 117997.
РоссияReferences
- Bennett C, Moayyedi P, Corley DA, DeCaesteck-er J, Falck-Ytter Y, Falk G, Vakil N, Sanders S, Vi-eth M, Inadomi J, Aldulaimi D, Ho KY, Odze R, Meltzer SJ, Quigley E, Gittens S, Watson P, Zaninotto G, Iyer PG, Alexandre L, Ang Y, Callaghan J, Harrison R, Singh R, Bhandari P, Biss-chops R, Geramizadeh B, Kaye P, Krishnadath S, Fennerty MB, Manner H, Nason KS, Pech O, Konda V, Ragunath K, Rahman I, Romero Y, Sampliner R, Siersema PD, Tack J, Tham TC, Trudgill N, Weinberg DS, Wang J, Wang K, Wong JY, Attwood S, Malfertheiner P, MacDonald D, Barr H, Ferguson MK, Jankowski J; BOB CAT Consortium. BOB CAT: A Large-Scale Review and Delphi Consensus for Management of Barrett's Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia. Am J Gastroenterol. 2015;110(5):662-82; quiz 683. doi: 10.1038/ajg.2015.55. Erratum in: Am J Gastroenterol. 2015;110(6):943.
- Зайратьянц ОВ, Кононова АВ, ред. Пищевод Барретта: клинические рекомендации Российского общества патологоанатомов [Интернет]. 2016. Доступно на: http://www.patolog.ru/news/utverzhdennye-rop-klinicheskie-rekomendacii-po-morfologicheskoy-di-agnostike-zabolevaniy.
- Biswas S, Quante M, Leedham S, Jansen M. The metaplastic mosaic of Barrett's oesophagus. Virchows Arch. 2018;472(1):43-54. doi: 10.1007/s00428-018-2317-1.
- Harrison R, Perry I, Haddadin W, McDonald S, Bryan R, Abrams K, Sampliner R, Talley NJ, Moayyedi P, Jankowski JA. Detection of intestinal metaplasia in Barrett's esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. Am J Gastroenterol. 2007;102(6):1154-61. doi: 10.1111/j.1572-0241.2007.01230.x.
- Bhat S, Coleman HG, Yousef F, Johnston BT, McManus DT, Gavin AT, Murray LJ. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst. 2011;103(13):1049— 57. doi: 10.1093/jnci/djr203. Erratum in: J Natl Cancer Inst. 2013;105(8):581.
- Sikkema M, Looman CW, Steyerberg EW, Kerkhof M, Kastelein F, van Dekken H, van Vuuren AJ, Bode WA, van der Valk H, Ouwendijk RJ, Giard R, Lesterhuis W, Heinhuis R, Klinken-berg EC, Meijer GA, ter Borg F, Arends JW, Kolkman JJ, van Baarlen J, de Vries RA, Mulder AH, van Tilburg AJ, Offerhaus GJ, ten Kate FJ, Kusters JG, Kuipers EJ, Siersema PD. Predictors for neoplastic progression in patients with Barrett's Esophagus: a prospective cohort study. Am J Gastroenterol. 2011 ;106(7):1231 —8. doi: 10.1038/ajg.2011.153.
- Duits LC, Phoa KN, Curvers WL, Ten Kate FJ, Meijer GA, Seldenrijk CA, Offerhaus GJ, Visser M, Meijer SL, Krishnadath KK, Tijssen JG, Mallant-Hent RC, Bergman JJ. Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut. 2015;64(5):700-6. doi: 10.1136/gut-jnl-2014-307278.
- Montgomery E, Goldblum JR, Greenson JK, Haber MM, Lamps LW, Lauwers GY, Lazen-by AJ, Lewin DN, Robert ME, Washington K, Zahurak ML, Hart J. Dysplasia as a predictive marker for invasive carcinoma in Barrett esophagus: a follow-up study based on 138 cases from a diagnostic variability study. Hum Pathol. 2001;32(4):379-88. doi: 10.1053/hupa.2001.23511.
- Kelty CJ, Gough MD, Van Wyk Q, Stephenson TJ, Ackroyd R. Barrett's oesophagus: intestinal metaplasia is not essential for cancer risk. Scand J Gastroenterol. 2007;42(11):1271-4. doi: 10.1080/00365520701420735.
- Avidan B, Sonnenberg A, Schnell TG, Chejfec G, Metz A, Sontag SJ. Hiatal hernia size, Barrett's length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma. Am J Gastroenterol. 2002;97(8):1930-6. doi: 10.1111/j.1572-0241.2002.05902.x.
- Desai TK, Krishnan K, Samala N, Singh J, Clu-ley J, Perla S, Howden CW. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis. Gut. 2012;61(7):970-6. doi: 10.1136/gut-jnl-2011-300730.
- Anaparthy R, Gaddam S, Kanakadandi V, Al-sop BR, Gupta N, Higbee AD, Wani SB, Singh M, Rastogi A, Bansal A, Cash BD, Young PE, Lieberman DA, Falk GW, Vargo JJ, Thota P, Sam-pliner RE, Sharma P. Association between length of Barrett's esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol. 2013;11(11):1430-6. doi: 10.1016/j.cgh.2013.05.007.
- Buttar NS, Wang KK, Sebo TJ, Riehle DM, Krishnadath KK, Lutzke LS, Anderson MA, Petterson TM, Burgart LJ. Extent of high-grade dysplasia in Barrett's esophagus correlates with risk of adenocarcinoma. Gastroenterology. 2001;120(7):1630-9. doi: 10.1053/gast.2001.25111.
- Thurberg BL, Duray PH, Odze RD. Polypoid dysplasia in Barrett's esophagus: a clinicopathologic, immunohistochemical, and molecular study of five cases. Hum Pathol. 1999;30(7):745--52. doi: 10.1016/s0046-8177(99)90134-x.
- Montgomery E, Bronner MP, Greenson JK, Haber MM, Hart J, Lamps LW, Lauwers GY, Lazenby AJ, Lewin DN, Robert ME, Washington K, Goldblum JR. Are ulcers a marker for invasive carcinoma in Barrett's esophagus? Data from a diagnostic variability study with clinical follow-up. Am J Gastroenterol. 2002;97(1):27-31. doi: 10.1111/j.1572-0241.2002.05420.x.
- Weston AP, Sharma P, Mathur S, Banerjee S, Jafri AK, Cherian R, McGregor D, Hassanein RS, Hall M. Risk stratification of Barrett's esophagus: updated prospective multivariate analysis. Am J Gastroenterol. 2004;99(9):1657-66. doi: 10.1111/j.1572-0241.2004.30426.x.
- Srivastava A, Hornick JL, Li X, Blount PL, Sanchez CA, Cowan DS, Ayub K, Maley CC, Reid BJ, Odze RD. Extent of low-grade dysplasia is a risk factor for the development of esophageal adenocarcinoma in Barrett's esophagus. Am J Gastroenterol. 2007;102(3):483-93; quiz 694. doi: 10.1111/j.1572-0241.2007.01073.x.
- Dar MS, Goldblum JR, Rice TW, Falk GW. Can extent of high grade dysplasia in Barrett's oesophagus predict the presence of adenocarcinoma at oesophagectomy? Gut. 2003;52(4):486-9. doi: 10.1136/gut.52.4.486.
- Schellnegger R, Quante A, Rospleszcz S, Schernhammer M, Hohl B, Tobiasch M, Pas-tula A, Brandtner A, Abrams JA, Strauch K, Schmid RM, Vieth M, Wang TC, Quante M. Goblet Cell Ratio in Combination with Differentiation and Stem Cell Markers in Barrett Esophagus Allow Distinction of Patients with and without Esophageal Adenocarcinoma. Cancer Prev Res (Phila). 2017;10(1):55-66. doi: 10.1158/1940-6207.
- Srivastava A, Golden KL, Sanchez CA, Liu K, Fong PY, Li X, Cowan DS, Rabinovitch PS, Reid BJ, Blount PL, Odze RD. High Goblet Cell Count Is Inversely Associated with Ploi-dy Abnormalities and Risk of Adenocarcinoma in Barrett's Esophagus. PLoS One. 2015;10(7):e0133403. doi: 10.1371/journal.pone.0133403.
Supplementary files
