Arra Antonio, Nieva Norma B, Rey Natividad, Fernández Angel O
Servicio de Patología Hospital Escuela de la Universidad Abierta Interamericana, Floresta, Capital Federal.
Rev Fac Cien Med Univ Nac Cordoba. 2005;62(3):57-62.
Barrett's esophagus (BE) has been identified as the most important risk factor for adenocarcinoma of the distal esophagus. BE has been categorized as long-segment (LSBE) if it extends 3 cm or more up the esophagus and as short-segment (SSBE) if it extends less than 3 cm into esophagus. Intestinal metaplasia may also develop in gastric mucosa (IMG) at the gastroesophageal junction. IMG has a much lower risk to progress to dysplasia or carcinoma when compared with SLBE or SSBE. Moreover, these conditions are difficult to distinguish one from another only based on endoscopic and morphologic criteria. Therefore the aim this study was to evaluate the cytokeratin (CK) 7 and 20 inmunoreactivity patterns in these intestinal metaplasias with the purpose to determine the precise anatomic site of the biopsy. Biopsy specimens from 14 patients with LSBE, 6 with SSBE and 7 patients with IMG were inmunohistochemically stained with monoclonal antibodies to CK 7 and 20. Barrett's CK7/20 pattern was characterized by superficial and deep CK7 reactivity and only superficial CK 20 staining in the intestinalized mucosa. This pattern was found in all 7 (100%) patients with LSBE, and was absent in all 7 patients with IMG. All biopsy specimens from patients with IMG showed no staining for CK7 and diffuse surface positivity for CK20. 67% of the biopsy specimens from patients with endoscopic SSBE showed Barrett's CK7/20 pattern, and the remaining 33% specimens showed the IMG staining pattern. Based on our data the inmunohistochemical determination of CK7/20 is an excelent tool with high specificity in distinguishing LSBE and SSBE from IMG.
巴雷特食管（BE）已被确认为食管远端腺癌的最重要危险因素。如果BE向上延伸至食管3厘米或更长，则被归类为长段型（LSBE）；如果延伸至食管小于3厘米，则为短段型（SSBE）。胃食管交界处的胃黏膜也可能发生肠化生（IMG）。与LSBE或SSBE相比，IMG进展为发育异常或癌的风险要低得多。此外，仅根据内镜和形态学标准很难区分这些情况。因此，本研究的目的是评估这些肠化生中细胞角蛋白（CK）7和20的免疫反应模式，以确定活检的精确解剖部位。对14例LSBE患者、6例SSBE患者和7例IMG患者的活检标本进行了CK 7和20单克隆抗体的免疫组织化学染色。巴雷特CK7/20模式的特征是肠化生黏膜中CK7在浅表和深部均有反应，而CK 20仅在浅表染色。在所有7例（100%）LSBE患者中均发现这种模式，而在所有7例IMG患者中均未发现。所有IMG患者的活检标本CK7均无染色，CK20呈弥漫性表面阳性。内镜诊断为SSBE患者的活检标本中，67%显示巴雷特CK7/20模式，其余33%的标本显示IMG染色模式。根据我们的数据，CK7/20的免疫组织化学测定是区分LSBE和SSBE与IMG的高特异性的优秀工具。
