The metaplastic mosaic of Barrett’s oesophagus

Abstract

Barrett’s oesophagus surveillance biopsies represent a significant share of the daily workload for a busy histopathology department. Given the emphasis on endoscopic detection and dysplasia grading, it is easy to forget that the benefits of these screening programs remain unproven. The majority of patients are at low risk of progression to oesophageal adenocarcinoma, and periodic surveillance of these patients is burdensome and costly. Here, we investigate the parallels in the development of Barrett’s oesophagus and other scenarios of wound healing in the intestine. There is now increased recognition of the full range of glandular phenotypes that can be found in patients’ surveillance biopsies, and emerging evidence suggests parallel pathways to oesophageal adenocarcinoma. Greater understanding of the conditions that favour progression to cancer in the distal oesophagus will allow us to focus resources on patients at increased risk.

Esophageal pepsin and proton pump synthesis in barrett's esophagus and esophageal adenocarcinoma

“…Several CLE‐positive cases in this study expressed pepsinogen and gastric H+/K+‐ATPase proton pump mRNA, consistent with previous reports of pepsin and acid production in BE . Both heterotopic gastric mucosa in the esophagus and BE contain diverse cell types, including oxyntocardiac mucosa characterized by parietal (acid secreting) and chief (pepsin secreting) cells . Evidence suggests that oxyntocardiac mucosa is a precursor of intestinal metaplasia and EAC, and it is commonly found in the background of EAC as observed herein .…”

“…31 Both heterotopic gastric mucosa in the esophagus and BE contain diverse cell types, including oxyntocardiac mucosa characterized by parietal (acid secreting) and chief (pepsin secreting) cells. 30,51 Evidence suggests that oxyntocardiac mucosa is a precursor of intestinal metaplasia and EAC, 52 and it is commonly found in the background of EAC as observed herein. 32 Accordingly, pepsin and proton pump mRNA was expressed exclusively in GERD-associated metaplasia and dysplasia in this study, and was absent from noncancer esophagus and squamous cell carcinomas, which bear no association with GERD.…”

Loss of the SWI/SNF-ATPase subunit members SMARCF1 (ARID1A), SMARCA2 (BRM), SMARCA4 (BRG1) and SMARCB1 (INI1) in oesophageal adenocarcinoma

“…The strategy for detecting amplifications of KRAS followed the recommendations KRAS/CEN12 ratio ≥ 2.0 or KRAS extrachromosomal cluster signals [32].…”

HER2 Heterogeneity in Personalized Therapy of Gastro-Oesophageal Malignancies: An Overview by Different Methodologies

“…It is fundamentally identified as columnar metaplasia which substitutes the stratified squamous epithelium of the distal esophagus [43]. Pathologists play an important role in surveillance of BE patients to identify precursor/dysplastic lesions by morphological assessment as well as discovering patients at high risk [44,45]. In detail, surface maturation, glandular design, cytologic atypia and presence of inflammation and erosions should be clearly identified as relevant morphological characteristics [44][45][46].…”

“…Pathologists play an important role in surveillance of BE patients to identify precursor/dysplastic lesions by morphological assessment as well as discovering patients at high risk [44,45]. In detail, surface maturation, glandular design, cytologic atypia and presence of inflammation and erosions should be clearly identified as relevant morphological characteristics [44][45][46]. Moreover, dysplasia in BE has been categorized into 4 groups on the basis of international consensus [46], similar to the aforementioned WHO classification of gastric dysplasia/intraepithelial neoplasia (Table 3).…”