Türkmen Ilknur Çetinaslan, Başsüllü Nuray, Uraz Süleyman, Yerdel Mehmet Ali, Memışoğlu Reşat, Bülbül Doğusoy Gülen
Department of Pathology, İstanbul Bilim University, Faculty of Medicine, İstanbul, Turkey.
Turk Patoloji Derg. 2012;28(3):251-8. doi: 10.5146/tjpath.2012.01132.
The description of Barrett's esophagus which is a risk factor for esophageal adenocarcinoma has differences, and the need of goblet cells for diagnosis is controversial. However, the pathophysiology in the metaplasia seen in Barrett's esophagus is not totally understood and new methods are searched for the assessment of progression to dysplasia. We aimed to search the immunohistochemical expression of CDX2, COX2 and MUC2 in Barrett's esophagus to detect any early evidence of intestinal metaplasia or dysplasia.
The staining properties were examined in the intestinal metaplastic (goblet cell-containing columnar epithelium), columnar (non-goblet columnar epithelium), distant columnar (non-goblet columnar epithelium distant from intestinal metaplastic epithelium) and squamous epithelium in 59 pathologically diagnosed Barrett's esophagus, 22 of which having dysplasia. The results were compared statistically with Pearson and Fisher exact tests.
The distribution of the staining of intestinal metaplastic, non-goblet columnar distant columnar, and squamous epithelium, respectively were as follows: for CDX2 76.3%, 23.7%, 1.7%, 0%; for COX-2 93.2%, 47.5%, 8%, 62.9%; for MUC2 93.2%, 11.9%, 4% and 0%. The expression of CDX2, COX2 and MUC2 in the intestinal metaplastic epithelium was higher than the expression in distant and non-goblet columnar epithelium. The expression of CDX2, COX2 and MUC2 in the foci of dysplasia decreased significantly (18.2%, 27.3%, 31.9%, and p=0.039, 0.0001, 0.0001, respectively). COX2 expression in squamous epithelium was also lower when the adjacent mucosa has dysplasia (p=0.014).
The CDX2, COX2 and MUC2 expressions were seen in the intestinal epithelium having goblet cells. The use of the markers in the diagnosis is controversial but the difference in the Barrett esophagus-dysplasia sequence seems to be meaningful.
巴雷特食管是食管腺癌的一个危险因素，其描述存在差异，且诊断中杯状细胞的必要性存在争议。然而，巴雷特食管中化生的病理生理学尚未完全明了，人们正在寻找评估其向发育异常进展的新方法。我们旨在研究CDX2、COX2和MUC2在巴雷特食管中的免疫组化表达，以检测肠化生或发育异常的任何早期证据。
对59例经病理诊断的巴雷特食管的肠化生（含杯状细胞的柱状上皮）、柱状（非杯状柱状上皮）、远处柱状（远离肠化生上皮的非杯状柱状上皮）和鳞状上皮的染色特性进行了检查，其中22例有发育异常。结果采用Pearson检验和Fisher精确检验进行统计学比较。
肠化生、非杯状柱状、远处柱状和鳞状上皮染色的分布情况分别如下：CDX2分别为76.3%、23.7%、1.7%、0%；COX-2分别为93.2%、47.5%、8%、62.9%；MUC2分别为93.2%、11.9%、4%和0%。CDX2、COX2和MUC2在肠化生上皮中的表达高于在远处和非杯状柱状上皮中的表达。发育异常灶中CDX2、COX2和MUC2的表达显著降低（分别为18.2%、27.3%、31.9%，p分别为0.039、0.0001、0.0001）。当相邻黏膜有发育异常时，鳞状上皮中COX2的表达也较低（p=0.014）。
CDX2、COX2和MUC2表达见于含有杯状细胞的肠上皮。这些标志物在诊断中的应用存在争议，但在巴雷特食管-发育异常序列中的差异似乎具有意义。
