Hamilton S R, Smith R R, Cameron J L
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Hum Pathol. 1988 Aug;19(8):942-8. doi: 10.1016/s0046-8177(88)80010-8.
The prevalence and characteristics of Barrett esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction are uncertain. We studied 61 consecutive esophagogastrectomy specimens with adenocarcinoma, which were subjected to extensive histopathologic examination. Barrett esophagus was found in 64% of the cases (39 of 61), but had been recognized in only 38% of the patients with Barrett-associated carcinoma who had undergone preoperative endoscopy with biopsy (13 of 34). The median extent of Barrett esophagus with adenocarcinoma was 5 cm (range, 1 cm to 12 cm), and distinctive-type ("specialized") Barrett mucosa predominated (35 of 39; 90%). The Barrett adenocarcinomas were centered in the distal esophagus 2 cm +/- 0.3 cm above the esophagogastric junction. The patients with Barrett adenocarcinoma showed a striking predominance of white men (34 of 39; 87%) in contrast to gastric adenocarcinoma cases (21 of 69; 30%) and to Barrett patients without carcinoma or dysplasia (75 of 149; 50%), but similar to patients having adenocarcinoma of the esophagus or esophagogastric junction without demonstrable Barrett esophagus (16 of 22; 73%). Our findings suggest that most adenocarcinomas of the esophagus or esophagogastric junction are Barrett carcinomas, rather than gastric cardiac cancers or other types of esophageal adenocarcinoma; most Barrett adenocarcinomas occur in short segments of Barrett esophagus, which may be difficult to detect at endoscopy; and white men with Barrett esophagus may constitute a clinically identifiable at-risk group suitable for surveillance.
食管或食管胃交界腺癌患者中Barrett食管的患病率及特征尚不确定。我们研究了61例连续的食管胃切除术腺癌标本，并对其进行了广泛的组织病理学检查。64%的病例（61例中的39例）发现有Barrett食管，但在术前接受内镜活检的Barrett相关癌患者中，只有38%被诊断出来（34例中的13例）。伴有腺癌的Barrett食管的中位长度为5厘米（范围1厘米至12厘米），且以特殊类型（“特化”）的Barrett黏膜为主（39例中的35例；90%）。Barrett腺癌集中在食管胃交界上方2厘米±0.3厘米的食管远端。与胃腺癌病例（69例中的21例；30%）以及无癌或发育异常的Barrett患者（149例中的75例；50%）相比，Barrett腺癌患者中白人男性占显著优势（39例中的34例；87%），但与无明显Barrett食管的食管或食管胃交界腺癌患者相似（22例中的16例；73%）。我们的研究结果表明，大多数食管或食管胃交界腺癌是Barrett癌，而非胃贲门癌或其他类型的食管腺癌；大多数Barrett腺癌发生在Barrett食管的短节段中，在内镜检查时可能难以检测到；患有Barrett食管的白人男性可能构成一个临床上可识别的高危群体，适合进行监测。
