Special requirements in the esophageal biopsies of Barrett's esophagus

Background: The incidence of gastroesopageal reflux disease (GERD) has increased over the past years as well as the number of Barrett's esophagus (BE) cases. The latter is defined as a replacement of stratified squamous epithelium by metaplastic glandular mucosa with a certain neoplastic potential. Thus, histopathologists have an important role in the evaluation of BE.

Aim: To review the morphological considerations and pitfalls which have an impact on the patients' clinical management.

Materials and methods: One hundred and five biopsy specimens from 88 patients with GERD and suspected either short segment or long segment BE were examined with HE, AB-PAS, Giemsa staining and using CD10, CK7, CK20, Muc-2, Muc-3, Muc-5AC antibodies.

Results: 35 cardia type, 27 fundus type and 35 intestinal type BE cases were found. In seven patients with endoscopically suspected BE, there was no sign of glandular metaplasia. In one case, pancreatic metaplasia was identified. CD10 highlighted the surface of enterocytes, CK7 and CK20 stained mucosa with intestinal metaplasia. Small intestinal, large intestinal and gastric mucin containing cells were labelled by Muc-2, Muc-3, Muc-5AC antibodies.

Conclusions: These observations highlight the importance of the correct assessment of changes occurring either in the stratified squamous epithelium or in the metaplastic glandular epithelium. Presence of acidic mucin containing goblet or pseudogoblet cells may also have diagnostical implication. Muc antibodies, CK7, CK20 and CD10 immunohistochemistry were found to be helpful in the separation of the different types of metaplastic glandular epithelium.