Hahn Hejin P, Shahsafaei Aliakbar, Odze Robert D
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Am J Surg Pathol. 2008 Oct;32(10):1454-61. doi: 10.1097/PAS.0b013e31817884fd.
A well-known type of mesenchymal/epithelial interaction occurs in Barrett esophagus (BE) characterized by the formation of a new, superficially located, muscularis mucosae (MM), which results in the division of the lamina propria (LP) into a superficial and deep compartment. The vascular and lymphatic properties of these 2 regions of LP are unknown. The risk of metastases of carcinomas that infiltrate these 2 anatomic areas also remains unclear. The aim of this study was to evaluate the density of blood vessels and lymphatic spaces within the superficial and deep LP and submucosa in patients with BE, and to compare the results to normal squamous-lined esophagus. Thirty esophago-gastrectomy specimens were stained immunohistochemically with CD31 (stains blood vessel and lymphatic endothelium) and D2-40 (stains lymphatic endothelium only). The density of CD31+ blood and lymphatic vessels (per 20 x field) in BE (superficial LP=37 and deep LP=38) was significantly lower compared with the LP of squamous-lined esophagus (68; P<0.001). However, the total number of blood and lymphatic vessels in the superficial and deep LP in BE was statistically similar to the LP of squamous-lined esophagus. The density of CD31+ blood and lymphatic vessels (per 20x field) in the submucosa of BE (21) was not significantly different from the submucosa of squamous-lined esophagus (23; P>0.05). We conclude that in BE, the "native" LP in squamous-lined esophagus is separated into 2 LP compartments (superficial and deep) by the formation of a new MM. These findings suggest that carcinomas that invade through the superficial MM into the deep LP should be considered "intramucosal" rather than "submucosal." Further outcome studies are needed to evaluate the risk of vascular/lymphatic metastasis in BE patients with different levels of LP invasion.
一种著名的间充质/上皮相互作用类型发生在巴雷特食管（BE）中，其特征是形成新的、位于浅表的黏膜肌层（MM），这导致固有层（LP）分为浅表和深部隔室。LP这两个区域的血管和淋巴管特性尚不清楚。浸润这两个解剖区域的癌转移风险也仍不明确。本研究的目的是评估BE患者浅表和深部LP及黏膜下层内血管和淋巴管腔隙的密度，并将结果与正常鳞状上皮食管进行比较。对30例食管胃切除术标本进行免疫组织化学染色，分别用CD31（标记血管和淋巴管内皮）和D2-40（仅标记淋巴管内皮）。与鳞状上皮食管的LP（68；P<0.001）相比，BE中CD31+血管和淋巴管的密度（每20×视野）在浅表LP为37，深部LP为38，显著降低。然而，BE浅表和深部LP中血管和淋巴管的总数在统计学上与鳞状上皮食管的LP相似。BE黏膜下层中CD31+血管和淋巴管的密度（每20×视野）为21，与鳞状上皮食管黏膜下层（23；P>0.05）无显著差异。我们得出结论，在BE中，鳞状上皮食管中的“天然”LP通过新MM的形成被分为两个LP隔室（浅表和深部）。这些发现表明，通过浅表MM侵入深部LP的癌应被视为“黏膜内”而非“黏膜下”。需要进一步的结果研究来评估不同LP浸润水平的BE患者血管/淋巴转移的风险。
