Conversion of Goblet to Non-Goblet Columnar Metaplasia of the Esophagus. A Clinical/Pathologic and Molecular Study of 8 Cases
Tanya A Rege, Carissa A Sanchez, Xiaohong Li, David S Cowan, Brian J Reid, Patricia L Blount, Robert D Odze. Brigham and Women's Hospital, Boston; Fred Hutchinson Cancer Research Center and University of Washington, Seattle
Background: In patients with Barrett's esophagus (BE), it is presumed that only columnar epithelium with goblet cells is at risk for neoplastic progression. We have noted, that a small proportion of patients with BE convert to non-goblet columnar epithelium. The aim of this study was to evaluate the clinical, pathologic and flow cytometric abnormalities of BE patients who have converted from goblet to non-goblet columnar epithelium. The results have implications with regard to the ACG definition of BE.
Design: During a 7 year period (2001-2008) in a prospective BE surveillance cohort in which all patients had 4 quadrant biopsies every 2 cm of esophagus, 8 BE patients out of 333 (2.4%) who converted from goblet to non-goblet cell columnar epithelium of the esophagus as confirmed in their last 2 surveillance endoscopies, were identified. After exclusion of 137 patients who had cancer or EMR during surveillance, the final (N=8) cases and controls (N=186) were evaluated for clinical and pathologic features, including flow cytometric characteristics.
Results: BE converters (mean follow-up = 59.6 months) showed a similar male/female ratio (5/3), but were significantly older (mean age: 67 years) compared to the 186 non-converters (mean follow-up = 48.7 months) (M/F:149/37, mean age: 63.7 years). Converters showed a significantly shorter mean length of esophageal columnar epithelium at baseline (1.6 cm, range: 1-6) and a significantly shorter length at last endoscopy (mean 1.3 cm, range 1-4) compared to non-converters (5.4 (1-17) and 5.0 (1-16), respectively, p<0.01 for both comparisons). The 8 converters showed a similar proportion of cases with tetraploidy (30%), aneuploidy (40%), or any flow abnormality (50%) compared to non-converters (23%, 16% and 31%, respectively, p> 0.05 for all comparisons). Immunohistochemical analysis demonstrated that the metaplastic epithelium of converters maintained positivity for intestinal differentiation markers. The prevalence rate of dysplasia/cancer in the two patient groups were statistically similar.
Conclusions: Conversion of goblet (BE) to non-goblet columnar epithelium of the esophagus is rare, but is more common in patients with shorter segments of columnar epithelium. Conversion of BE to non-goblet epithelium is not associated with loss of flow cytometric abnormalities nor loss of expression of intestinal differentiation markers, suggesting that these patients may still be at risk for cancer and should remain in endoscopic surveillance.
Monday, March 19, 2012 1:00 PM
Poster Session II # 80, Monday Afternoon