Gottfried M R, McClave S A, Boyce H W
Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710.
Am J Clin Pathol. 1989 Dec;92(6):741-6. doi: 10.1093/ajcp/92.6.741.
To investigate the distribution and specificity of intestinal metaplasia (IM) in columnar lined esophagus (CLE), the authors reviewed biopsies of the hiatal hernia pouch (HHP) and esophagus from 17 patients with CLE (84 biopsies) and 10 controls (25 biopsies). The proximal margin of the gastric folds was used as an endoscopic landmark, corresponding to the gastroesophageal muscular junction (GEMJ). No biopsies obtained above the GEMJ in control patients showed columnar mucosa. No goblet cell metaplasia was seen in 21 biopsies of the HHP from patients with CLE or in 13 corresponding biopsies from controls. In contrast, alcian blue (AB) stains showed diffuse acid mucins in 3 of 21 biopsies of the HHP from patients with CLE and in 10 of 13 corresponding biopsies from controls, demonstrating that goblet cell metaplasia clearly distinguishes biopsies of CLE from the HHP (P less than 0.01), whereas small amounts of diffuse acid mucin on AB stains do not. IM evidenced by goblet cell metaplasia was frequently seen in biopsies only 2-3 cm above the GEMJ, and CLE was limited to that area in three patients, suggesting that the distal esophagus cannot be dismissed as a site for metaplastic and possibly premalignant mucosa. Adenocarcinoma was diagnosed during the course of the study in one patient with only 5 cm of columnar mucosa above the GEMJ.
为研究柱状上皮内衬食管（CLE）中肠化生（IM）的分布及特异性，作者回顾了17例CLE患者的食管裂孔疝囊（HHP）及食管活检标本（84份活检）和10例对照者的活检标本（25份活检）。胃皱襞的近端边缘用作内镜标志，对应于胃食管肌性交界（GEMJ）。对照患者在GEMJ上方获取的活检标本均未显示柱状黏膜。CLE患者的21份HHP活检标本及对照者的13份相应活检标本中均未见杯状细胞化生。相比之下，阿尔辛蓝（AB）染色显示，CLE患者的21份HHP活检标本中有3份及对照者的13份相应活检标本中有10份存在弥漫性酸性黏蛋白，这表明杯状细胞化生可明确区分CLE与HHP的活检标本（P<0.01），而AB染色上少量的弥漫性酸性黏蛋白则不能。杯状细胞化生所证实的IM常见于GEMJ上方仅2 - 3 cm处的活检标本中，3例患者的CLE局限于该区域，提示远端食管不能被排除作为化生及可能的癌前黏膜的部位。在研究过程中，1例患者在GEMJ上方仅5 cm处的柱状黏膜被诊断为腺癌。
