Glickman J N, Wang H, Das K M, Goyal R K, Spechler S J, Antonioli D, Odze R D
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Am J Surg Pathol. 2001 Jan;25(1):87-94. doi: 10.1097/00000478-200101000-00010.
The pathogenesis of short segment Barrett's esophagus (SSBE) and intestinal metaplasia (IM) of the gastroesophageal junction (IMGEJ) are poorly understood. Also, these conditions are difficult to distinguish from one another based solely on endoscopic and pathologic criteria. Therefore, the aim of this study was to evaluate the immunophenotypic features of SSBE and IMGEJ and to compare the results with lesions of known etiologies: long segment BE (LSBE) caused by reflux disease and Helicobacter pylori-induced IM of the gastric antrum (IMGA). Routinely processed mucosal biopsy specimens from 11 patients with LSBE, 17 with SSBE, 10 with IMGEJ, 16 with IMGA, 17 with a normal nonmetaplastic GEJ, and 7 patients with a normal gastric antrum were immunohistochemically stained with monoclonal antibodies to: Das1, an antibody shown to react specifically with colonic goblet cells; 45M1, an antibody that recognizes the M1 gastric mucin antigen; and cytokeratin (CK) 7 and 20, antibodies that have previously been reported to show specific staining patterns in BE versus IMGA. Also evaluated was nonintestinalized mucinous epithelium from LSBE, SSBE, and also the normal GEJ and gastric antrum. LSBE, SSBE, and IMGEJ showed similar prevalences of Das1 (91% versus 88% versus 100%) and 45M1 reactivity (100% versus 100% versus 100%), and a similar pattern of CK7/20 reactivity (diffuse strong CK7 staining of the surface and crypt epithelium, and strong surface and superficial crypt CK20 staining) (91% versus 94% versus 90%). In contrast, although 45M1 reactivity in IMGA (93%) was similar to that of the other three groups, IMGA showed a significantly lower prevalence of Das positivity (13%, p < 0.001), and only a 14% prevalence of the CK7/20 staining pattern that was predominant in the other three groups (p < 0.001). Das1, 45M1, and CK7/20 staining were similar in nonintestinalized "cardia-type" mucinous epithelium from LSBE, SSBE, and the GEJ, but all were distinct from the normal gastric antrum. In summary, the immunophenotypic features of SSBE and IMGEJ are similar and closely resemble those seen in classic LSBE, but are distinct from IMGA. This may indicate that IM in LSBE, SSBE and at the GEJ have similar biologic properties. Based on our data, SSBE and IMGEJ cannot be distinguished on the basis of their immunophenotype.
短节段巴雷特食管（SSBE）和胃食管交界部肠化生（IMGEJ）的发病机制尚不清楚。此外，仅根据内镜和病理标准很难将这些情况相互区分。因此，本研究的目的是评估SSBE和IMGEJ的免疫表型特征，并将结果与已知病因的病变进行比较：反流性疾病引起的长节段BE（LSBE）和幽门螺杆菌诱导的胃窦肠化生（IMGA）。对11例LSBE患者、17例SSBE患者、10例IMGEJ患者、16例IMGA患者、17例正常非化生胃食管交界部患者和7例正常胃窦患者的常规处理的黏膜活检标本进行免疫组织化学染色，使用针对以下物质的单克隆抗体：Das1，一种已证明能与结肠杯状细胞特异性反应的抗体；45M1，一种识别M1胃黏液抗原的抗体；以及细胞角蛋白（CK）7和20，此前有报道称这两种抗体在BE与IMGA中显示出特定的染色模式。还评估了LSBE、SSBE以及正常胃食管交界部和胃窦的非肠化生黏液上皮。LSBE、SSBE和IMGEJ显示出相似的Das1阳性率（分别为91%、88%和100%）和对45M1的反应性（分别为100%、100%和100%），以及相似的CK7/20反应模式（表面和隐窝上皮弥漫性强CK7染色，表面和浅表隐窝强CK20染色）（分别为91%、94%和90%）。相比之下，尽管IMGA中45M1的反应性（93%）与其他三组相似，但IMGA的Das阳性率显著较低（13%，p<0.001），且仅有14%的患者具有在其他三组中占主导的CK7/20染色模式（p<0.001）。LSBE、SSBE和胃食管交界部的非肠化生“贲门型”黏液上皮中的Das1、45M1和CK7/20染色相似，但均与正常胃窦不同。总之，SSBE和IMGEJ的免疫表型特征相似，与经典LSBE中所见的特征非常相似，但与IMGA不同。这可能表明LSBE、SSBE和胃食管交界部的肠化生具有相似的生物学特性。根据我们的数据，无法根据免疫表型区分SSBE和IMGEJ。
