Naini Bita V, Souza Rhonda F, Odze Robert D
*Department of Pathology & Lab Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA †Department of Medicine, University of Texas Southwestern Medical Center and the VA North Texas Health Care System ‡Esophageal Diseases Center, University of Texas Southwestern Medical Center and the VA North Texas Health Care System, Dallas, TX §Pathology Department, Brigham & Women's Hospital, Boston, MA.
Am J Surg Pathol. 2016 May;40(5):e45-66. doi: 10.1097/PAS.0000000000000598.
This review provides a summary of our current understanding of, and the controversies surrounding, the diagnosis, pathogenesis, histopathology, and molecular biology of Barrett's esophagus (BE) and associated neoplasia. BE is defined as columnar metaplasia of the esophagus. There is worldwide controversy regarding the diagnostic criteria of BE, mainly with regard to the requirement to histologically identify goblet cells in biopsies. Patients with BE are at increased risk for adenocarcinoma, which develops in a metaplasia-dysplasia-carcinoma sequence. Surveillance of patients with BE relies heavily on the presence and grade of dysplasia. However, there are significant pathologic limitations and diagnostic variability in evaluating dysplasia, particularly with regard to the more recently recognized unconventional variants. Identification of non-morphology-based biomarkers may help risk stratification of BE patients, and this is a subject of ongoing research. Because of recent achievements in endoscopic therapy, there has been a major shift in the treatment of BE patients with dysplasia or intramucosal cancer away from esophagectomy and toward endoscopic mucosal resection and ablation. The pathologic issues related to treatment and its complications are also discussed in this review article.
本综述总结了我们目前对巴雷特食管（BE）及其相关肿瘤的诊断、发病机制、组织病理学和分子生物学的理解以及围绕这些方面的争议。BE被定义为食管的柱状上皮化生。关于BE的诊断标准在全球范围内存在争议，主要涉及活检组织学鉴定杯状细胞的要求。BE患者患腺癌的风险增加，腺癌按照化生-发育异常-癌的顺序发展。对BE患者的监测很大程度上依赖于发育异常的存在和分级。然而，在评估发育异常方面存在显著的病理学局限性和诊断变异性，特别是对于最近才认识到的非传统变体。基于非形态学的生物标志物的鉴定可能有助于对BE患者进行风险分层，这是一个正在进行研究的课题。由于内镜治疗的最新进展，对于有发育异常或黏膜内癌的BE患者的治疗已发生重大转变，从食管切除术转向内镜黏膜切除术和消融术。本文还讨论了与治疗及其并发症相关的病理学问题。
