On the histogenesis of Barrett's oesophagus and its associated squamous islands: a three-dimensional study of their morphological relationship with native oesophageal gland ducts

Abstract

Current hypotheses concerning the histogenesis and regression of Barrett's oesophagus are based predominantly on animal models. Our study was formulated to assess, in human tissue, the morphological relationship between oesophageal gland ducts and both Barrett's oesophagus and their associated squamous islands. Serial sections were cut through a total of 46 blocks of archived oesophageal resection tissue containing oesophageal gland ducts underlying Barrett's epithelium. Serial sections were also taken through 15 squamous islands, taken from the same archived tissue, to assess their underlying histology: 21 of the ducts opened onto overlying Barrett's epithelium; in 17 there was a relatively sharp distinction between the two cell types, at the junction, whereas in four there was continuity and a gradual morphological change between the cells of the oesophageal gland ducts and the Barrett's epithelium. All 15 squamous islands sectioned were found to be continuous with an underlying gland duct. This study suggests an interrelationship between Barrett's epithelium and oesophageal gland ducts. More definitively we confirm that squamous islands are universally associated with oesophageal gland duct epithelium. These findings are of fundamental importance for the development of more targeted management strategies for Barrett's oesophagus. Copyright © 2005 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Barrett's Oesophagus

“…These include squamous islands within glandular mucosa, (especially when they are juxtaposed to oesophageal gland ducts), squamous epithelium overlying intestinalised crypts and hybrid glands [21,62,63]. The last are glands with a bimodal composition of intestinalised epithelium in the superficial aspect and cardiac-type epithelium below [62] (Figure 5.5).…”

“…Proximal extension of gastric epithelium to replace the damaged squamous epithelium could not explain the development of CLO and alternative proposed mechanisms are metaplasia of stratified squamous epithelium or migration of columnar cells from native oesophageal glands or their ducts [20]. Candidate cells of origin include multipotential stem cells at the basal aspect of the squamous mucosa of the oesophagus and the cells lining oesophageal gland ducts [21].…”

Small cell carcinoma with concomitant adenocarcinoma arising in a Barrett’s oesophagus: report of a case with a favourable behaviour

“…Metaplastic epithelium with goblet cells and numerous chromogranin positive cells (immunoperoxydase ×200) [8,24] and the presence of small foci of squamous, glandular or mucoepidermoid differentiation sometimes found in predominant SmCC [19]. Furthermore, the totipotent cells may be the source of regenerative squamous islands lying within Barrrett's metaplasia [5,9]. In our case, the SmCC component was located beneath a squamous island and encompassed, in its center, a remaining oesophageal gland duct.…”

“…Moreover, it has been postulated that composite tumours might derive from totipotent stem cells, leading to a proliferation with multidirectional differentiation. Some authors have proposed that these totipotent cells could originate from the oesophageal epithelium or in the submucosal gland ducts of the distal third of the oesophagus [5,9]. This could thus explain the reported observations with combined squamous cell carcinomas, adenocarcinomas, endocrine carcinomas and sarcomas of the oesophagus Fig.…”

Cyclooxygenase-2 expression in esophageal epithelium before and after photodynamic therapy for Barrett’s esophagus with high-grade dysplasia or intramucosal carcinoma

“…Current interest and attention is focused upon the concept of a pluripotent esophageal stem cell, responsible for development of esophageal squamous epithelium/ neosquamous epithelium, or, in an alternate pathway, metaplastic development of BE. While the precise location of the esophageal stem cell has yet to be precisely defined, one hypothesis is that these cells are located in the esophageal gland ducts [18][19][20]. Genotypic and phenotypic variation, including COX-2 expression, in this squamous population may therefore have implications for progression to either remission or recurrence of BE following endoscopic eradication therapy.…”