Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Room H-188, Atlanta, GA, 30322, USA,
Virchows Arch. 2014 Aug;465(2):135-43. doi: 10.1007/s00428-014-1590-x. Epub 2014 May 27.
The esophageal submucosal glands (SMG) protect the squamous epithelium from insults such as gastroesophageal reflux disease by secreting mucins and bicarbonate. We have observed metaplastic changes within the SMG acini that we have termed oncocytic glandular metaplasia (OGM), and necrotizing sialometaplasia-like change (NSMLC). The aim of this study is to evaluate the associated clinicopathological parameters of, and to phenotypically characterize the SMG metaplasias. Esophagectomy specimens were retrospectively assessed on hematoxylin and eosin sections and assigned to either a Barrett's esophagus (BE) or non-BE control group. Clinicopathologic data was collected, and univariate analysis and multivariate logistic regression models were performed to assess the adjusted associations with NSMLC and OGM. Selected cases of SMG metaplasia were characterized. SMG were present in 82 esophagi that met inclusion criteria. On univariate analysis, NSMLC was associated with BE (p = 0.002). There was no relationship between NSMLC and patient age, sex, tumor size, or treatment history. OGM was associated with BE (p = 0.031). No relationship was found between OGM and patient age, sex, or tumor size. On multivariate analysis, BE was independently associated with NSMLC (odds ratio [OR] 4.95, p = 0.003). Treatment history was also independently associated with OGM (p = 0.029), but not NSMLC. Both NSMLC and OGM were non-mucinous ductal type epithelia retaining a p63-smooth muscle actin co-positive myoepithelial cell layer. NSMLC and OGM were present in endoscopic mucosal resection specimens. Our study suggests that SMG metaplasia is primarily a reflux-induced pathology. NSMLC may pose diagnostic dilemmas in resection specimens or when only partially represented in mucosal biopsies or endoscopic resection specimens.
食管黏膜下腺（SMG）通过分泌黏液和碳酸氢盐来保护鳞状上皮免受胃食管反流病等刺激。我们观察到 SMG 腺泡内发生的化生改变，我们称之为嗜酸细胞性腺性化生（OGM）和坏死性唾液腺样化生样改变（NSMLC）。本研究旨在评估与 SMG 化生相关的临床病理参数，并对其进行表型特征分析。对苏木精和伊红切片的食管切除术标本进行回顾性评估，并分为 Barrett 食管（BE）或非 BE 对照组。收集临床病理数据，并进行单因素分析和多变量逻辑回归模型，以评估与 NSMLC 和 OGM 相关的调整关联。对 SMG 化生的选定病例进行了特征描述。符合纳入标准的 82 例食管存在 SMG。单因素分析显示，NSMLC 与 BE 相关（p = 0.002）。NSMLC 与患者年龄、性别、肿瘤大小或治疗史之间无关系。OGM 与 BE 相关（p = 0.031）。OGM 与患者年龄、性别或肿瘤大小之间未发现关系。多变量分析显示，BE 与 NSMLC 独立相关（比值比 [OR] 4.95，p = 0.003）。治疗史也与 OGM 独立相关（p = 0.029），但与 NSMLC 无关。NSMLC 和 OGM 均为非黏液性导管型上皮，保留 p63-平滑肌肌动蛋白共阳性的肌上皮细胞层。NSMLC 和 OGM 存在于内镜黏膜切除术标本中。我们的研究表明，SMG 化生主要是一种反流诱导的病理。在切除标本中，或仅在黏膜活检或内镜切除标本中部分表现时，NSMLC 可能会引起诊断难题。
