Glickman Jonathan N, Shahsafaei Aliakbar, Odze Robert D
Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Am J Surg Pathol. 2003 Oct;27(10):1357-65. doi: 10.1097/00000478-200310000-00008.
It is important to distinguish Barrett's esophagus (BE) from intestinal metaplasia related to carditis because these conditions have a different natural history, risk of malignancy, and treatment. However, the distinction between these entities is difficult both clinically and pathologically. The aim of this study was to evaluate and compare the immunostaining pattern of five mucin core polypeptides in BE to cases of carditis or antritis with intestinal metaplasia. Routinely processed mucosal biopsies from 22 patients with intestinal-type BE, 24 patients with cardia intestinal metaplasia (10 Helicobacter pylori positive), 17 patients with antral intestinal metaplasia (all H. pylori positive), 20 control patients with a normal antrum, and 22 control patients with a normal cardia were immunostained with monoclonal antibodies against MUC1, MUC2, MUC3, MUC5AC, and MUC6 mucin core polypeptides. Staining was evaluated separately for goblet cells and non-goblet columnar cells and compared between all groups. A significantly higher number of BE cases (P < 0.05) showed goblet cell staining for MUC1 (55%) or MUC6 (32%) compared with patients with carditis with intestinal metaplasia (MUC1 14%, MUC6 7%) or antritis with intestinal metaplasia (MUC1 6%, MUC6 0%). BE also showed a higher frequency of MUC1 and MUC6 positivity in non-goblet columnar cells compared with carditis and antritis cases with intestinal metaplasia. Only cases of BE showed combined MUC1 and MUC6 staining (sensitivity 23%, specificity 100%). The sensitivity and specificity of MUC1 staining for BE are 55% and 96%, respectively, and for MUC6 staining 30% and 96%, respectively. Interestingly, normal gastric cardia mucosa also showed a significantly higher prevalence of MUC2 and MUC3 expression in glandular epithelium (29% and 38%, respectively) compared with the antrum (0% for both markers) (P < 0.05). In conclusion, MUC1 and MUC6 expression in BE is distinct from that of the cardia and antrum with intestinal metaplasia; thus, immunophenotyping for these markers may have some value in a subset of patients in helping to separate BE from patients with intestinal metaplasia of the cardia. Columnar epithelium in the "normal" gastric cardia has a partially intestinalized phenotype and, as a result, may represent an early form of metaplastic epithelium.
区分巴雷特食管（BE）与贲门炎相关的肠化生很重要，因为这些病症具有不同的自然病史、恶性风险及治疗方法。然而，在临床和病理上区分这些实体都很困难。本研究的目的是评估和比较BE中五种粘蛋白核心多肽的免疫染色模式与贲门炎或胃窦炎伴肠化生的病例。对22例肠型BE患者、24例贲门肠化生患者（10例幽门螺杆菌阳性）、17例胃窦肠化生患者（均为幽门螺杆菌阳性）、20例胃窦正常的对照患者以及22例贲门正常的对照患者的常规处理的黏膜活检标本，用抗MUC1、MUC2、MUC3、MUC5AC和MUC6粘蛋白核心多肽的单克隆抗体进行免疫染色。分别评估杯状细胞和非杯状柱状细胞的染色情况，并在所有组之间进行比较。与贲门炎伴肠化生患者（MUC1 14%，MUC6 7%）或胃窦炎伴肠化生患者（MUC1 6%，MUC6 0%）相比，BE病例中杯状细胞MUC1染色（55%）或MUC6染色（32%）的数量显著更高（P < 0.05）。与贲门炎和胃窦炎伴肠化生病例相比，BE在非杯状柱状细胞中MUC1和MUC6阳性的频率也更高。只有BE病例显示MUC1和MUC6联合染色（敏感性23%，特异性达100%）。MUC1染色对BE的敏感性和特异性分别为55%和96%，MUC6染色的敏感性和特异性分别为30%和96%。有趣的是，正常胃贲门黏膜腺上皮中MUC2和MUC3表达的患病率也显著高于胃窦（两种标志物均为0%）（P < 0.05）。总之，BE中MUC1和MUC6的表达与贲门和胃窦伴肠化生的情况不同；因此，这些标志物的免疫表型分析在一部分患者中可能有助于区分BE与贲门肠化生，具有一定价值。“正常”胃贲门中的柱状上皮具有部分肠化生表型，因此可能代表化生上皮的早期形式。
