Does Barrett's Carcinoma Always Arise from Intestinal Metaplasia? Detailed Histologic Examination of EMR Specimens
Junko Aida, Tomio Arai, Michael Vieth, Christian Ell, Andrea May, Horst Neuhaus, Kaiyo Takubo. Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Dr. Horst Schmidt Clinic, Wiesbaden, Germany; Evangelisches Krankenhaus, Duesseldorf, Germany
Background: The diagnostic criteria for Barrett's esophagus in the USA include the presence of intestinal metaplasia with goblet cells. This is because, in the USA, Barrett's carcinoma is considered to arise only in intestinal-type mucosa. We have reported that cardiac, rather than intestinal-type, mucosa is observed in the background of minute Barrett's carcinoma (Hum Pathol 2009, 40: 65-74). However, as we examined only one histologic section in each case, this may have been insufficient for determining the cancer origin. Therefore, we examined all sections and confirmed all borders between Barrett's carcinoma and surrounding mucosa.
Design: We examined 665 microscopic sections of Barrett's carcinoma within the mucosal layer from 56 endoscopic mucosal resection (EMR) specimens, and categorized histologically all of the non-neoplastic mucosae adjacent to Barrett's carcinoma as either the cardiac/fundic or intestinal type. In each case, we also estimated the proportion occupied by each mucosal type, for which purpose we carried out immunohistologic staining for mucin (MUC2, MUC 5AC, and MUC6).
Results: Histologically, the 56 tumors were either papillary or well to moderately differentiated tubular adenocarcinoma. Twenty-six cases (46.4%) comprised cardiac-type mucosa alone, and 12 (21.4%) were surrounded predominantly by cardiac-type and partly by intestinal-type mucosa. Twelve other cases (21.4%) comprised intestinal-type mucosa alone, and four (7.1%) were surrounded predominantly by intestinal-type and partly by cardiac-type mucosa. Two cases (3.6%) were surrounded equally by cardiac- and intestinal-type mucosa.
Conclusions: Cardiac-type mucosa is located adjacent to carcinoma much more frequently than is intestinal-type mucosa, thus supporting the former study. Therefore, it cannot be proven histogenetically that the background mucosa of Barrett's carcinoma is the intestinal type. In addition, from this histogenetic standpoint, it seems better to define Barrett's esophagus as metaplastic columnar-lined esophagus alone, without requiring the presence of goblet cells.
Monday, March 4, 2013 1:00 PM
Poster Session II # 113, Monday Afternoon