Clinical and morphological analysis of dysplasia in Barrett's esophagus and columnar-lined esophagus

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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.

Russian Federation

K. 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.

Russian Federation

E. 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.

Russian Federation

A. 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.

Russian Federation

N. 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.

Russian Federation

N. 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.

Russian Federation

L. 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.

Russian Federation

A. 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.

Russian Federation

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Copyright (c) 2020 Mikhaleva L.M., Voytkovskaya K.S., Fedorov E.D., Birukov A.E., Gracheva N.A., Shegoleva N.N., Chigrai L.V., Shidii-Zakrua A.V.

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