Esophagus, histology

Chatelain D, Flejou JF. High-grade dysplasia and superficial adenocarcinoma in Barrett s esophagus histological mapping and exptession of p53, p21 and Bcl-2 oncoproteins. Virchows Arch. 2003 442 18-24. 

Reid BJ, Levine DS, Longton G, et al. Predictors of progression to cancer in Barrett s esophagus baseline histology and flow cytometry identify low- and high-risk patient subsets. Am J Gastroenterol. 2000 95 1669-1676. 

The patients were elderly, and many had no symptoms referable to the esophagus until their admission to the hospital. Death usually occurred from perforation into a large vessel, the pericardium, the mediastinum, or the pleural cavity, although some died of pneumonia. Of interest was the fact that few exhibited symptoms of esophageal obstruction. Tileston further reported that the histology of such ulcers was identical to that of chronic gastric ulcer, and that the adjacent mucosa was gastric in type. He assumed it to be ectopic, because it lined the lower part of the gut in the mediastinum. 

The histologic changes in the lining of the lower esophagus are associated with topographic alterations of considerable biologic and clinical importance. 

A reevaluation of the approach to Barrett s esophagus has been proposed by S. Spechler and R. Goyal. Intestinal metaplasia may represent the critical variable of most pathologic significance. Unfortunately, the histologic recognition of the entity does not necessarily enable accurate prediction of its biologic behavior. 

The studies mentioned above suggest that flow-cytometric and p53 abnormalities may be earlier and more specific markers for cancer development than the histologic finding of dysplasia. Nevertheless, these markers do not yet provide sufficient additional information to justify their routine application in clinical practice. Indeed, none of the biomarkers listed in the table provides such information. Despite the problems, at this time, the finding of dysplasia remains the most appropriate biomarker for the clinical evaluation of patients with Barrett s esophagus. 

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