M a l i g n a n c y a n d p r e m a l i g n a n c y in B a r r e t t ' s e s o p h a g u s : a c l i n i c a l - e n d o s c o p i c a l - a n d h i s t o l o g i c a l s t u d y
I . C . E . W E S D O R P , J. B A R T E L S M A N , M . E . I . S C H I P P E R , J. O F F E R H A U S , G . N . T Y T G A T
University of A m s t e r d a m , D e p a r t m e n t of M e d i c i n e , D i v i s i o n o f G a s t r o e n t e r o l o g y , P a t h o l o g y and N u c l e a r M e d i c i n e , W i l h e l m i n a G a s t h u i s , 1 ~ H e l m e r s s t r a a t 1 0 4 ,
1 0 5 4 E G A m s t e r d a m ( T h e N e t h e r l a n d s )
L6sions canc6reuse et pr6-cancdreuse sur oesophage de Barrett : Etude clinique, endoscopique et histologique
SUMMARY In ,this study, 14 patien.ts wi,th esophageal adeno- carci,noma ~arr.ounded by col,um~ar lined (Bar.r~t) epi- thelium were ~nvesti~gated, to lea, rn more about the ol~n,ical, endoscopical and especi'al:ly h~i~stologica,1 cha- racteri~t,ics .of th~s ma~gn.an, t cond,ition. Nearly all pati,en,ts compl,ai, n,ed of d,yspha'gia a~d weight loss
~nd had exporienced~ reflux s.ymptoms i,n .the past.
The macro~z~iric ~ppea~nce of ,the tumors was vari,able : superficia~ spreaffing (1), exophytous gro- wi, ng (4), mul.~ifocal (1), ~ista,l, mal~,gnaaa,t ulcer (4) or ulcera~fi,ng stenosi,ng type (4). Histology of biopsie.s from the tumor ~n~ from the surrou,nding Barrett epi.theli~tm revealed a poorly/modera,t,e differentiated
adenocarcinoma.
The junctional type epithelium was present in all patients with moderate to severe dysplastic changes in alil biopsies. Th.e~re dysplastic c h ~ g e s we,re obser-
ved in just over half of the biopsies containing the specialized columnar epithelium and not in the gas- tric fundic type epithelium. These results were compared with the histological findings in 200 fiber- endoscopical Barrett esophagus biopsies of 50 pa- tients without malignancy. Dysplastic changes were observed in 18 % of the biopsy material : in 16 % in junctional type and in 2 % in specialized co- lumnar epithelium. The results of these light mi- croscopic fi,ndings correspond ~to the fi, rst prelimiaa,ary resul.ts of an ongoing cell proli.feraiion study w~th au~orad.i,ography of biopsies t akea~ from the area around a Barrett carcinoma which often show ex- pan.simon of the prol.ife,rative compartment in the junction'al type, only sporadically i~n the specialized c~.lum,n~r type and not in, ,the gastric fundic type epi,thelivm.
R~SUMI~
14 patients porteurs d'addnocarcinome oesophagien entourd de muqueuse de type cylindrique (Barrett) ont ~td investigu~s sur le plan clinique, endoseopique et ont s soumis h une ~tude histologique sp~ciale des'tinge d caract~riser l'environnement muqueux de eette ls maligne. Pratiquement t o u s l e s patients se plaignaient de dysphagie, de perte ponddrale et avaient pr~,~ent~ ant~rieurement des sympt6mes de reflux gastro-cesophagien. Les aspects tumoraux ont
~tO variables : envahissement super/iciel (1), crois- sance exophytique (4), multi/ocale (1), ulceration maligne distale (4) ou ulceration st~nosante (4). Les biopsies pr~lev~es au niveau de la tumeur et dam"
I'~pith~lium eylindrique type Barrett environnant ont
r~vs des ad~nocarcinomes peu ou mod~r~ment di[fOrenci~s.
La muqueuse de type cardial (MC) ~tait prs chez t o u s l e s patients avec des degr~s de dysplasie sdvkre ou mod~r~e observes sur toutes les biopsies.
Ces changements dysplasiques ont ~td observes dans un pea plus de la moiti~ des biopsies de muqueuse type cylindrique avec m~taplasie intestinale (MCMI) et manquaient au niveau des muqueuses de type /un- dique (MF). Ces r~sultats ont ~t~ eompards avec les donn~es histologiques de 200 biopsies endoscopiques pr6tev~es ehez 50 patients porteurs d'endobraehy- oesophage sans l~sion maligne. Des changements dys-
Add~'ess for reprints : D" I.C.E. WESDORP, Dep.
Gastroenterology, Andreas Ziekenhuis, T. De Bock- straat 8, 1058 NR Amsterdam (The Netherlands).
Key-words : adenocarcinoma, Ba, rrett's epithelium, dyspl,~i,a, endoscopy, esophagus, esophag~ti~s.
Mots-clks : ad6nocarcinome ces~phagien, dysplasie, endoscopic, 6pi~th61i,um de Barrett, 0esophagi,te.
Acta Endoscopica Tome X I - N ~ 4-5 - 1981 3 1 7
Cet article des Editions Lavoisier est disponible en acces libre et gratuit sur archives-acen.revuesonline.com
M a l i g n a n c y a n d p r e m a l i g n a n c y in B a r r e t t ' s e s o p h a g u s : a c l i n i c a l - e n d o s c o p i c a l - a n d h i s t o l o g i c a l s t u d y
I . C . E . W E S D O R P , J. B A R T E L S M A N , M . E . I . S C H I P P E R , J. O F F E R H A U S , G . N . T Y T G A T
University of A m s t e r d a m , D e p a r t m e n t of M e d i c i n e , D i v i s i o n o f G a s t r o e n t e r o l o g y , P a t h o l o g y and N u c l e a r M e d i c i n e , W i l h e l m i n a G a s t h u i s , 1 ~ H e l m e r s s t r a a t 1 0 4 ,
1 0 5 4 E G A m s t e r d a m ( T h e N e t h e r l a n d s )
L6sions canc6reuse et pr6-cancdreuse sur oesophage de Barrett : Etude clinique, endoscopique et histologique
SUMMARY In ,this study, 14 patien.ts wi,th esophageal adeno- carci,noma ~arr.ounded by col,um~ar lined (Bar.r~t) epi- thelium were ~nvesti~gated, to lea, rn more about the ol~n,ical, endoscopical and especi'al:ly h~i~stologica,1 cha- racteri~t,ics .of th~s ma~gn.an, t cond,ition. Nearly all pati,en,ts compl,ai, n,ed of d,yspha'gia a~d weight loss
~nd had exporienced~ reflux s.ymptoms i,n .the past.
The macro~z~iric ~ppea~nce of ,the tumors was vari,able : superficia~ spreaffing (1), exophytous gro- wi, ng (4), mul.~ifocal (1), ~ista,l, mal~,gnaaa,t ulcer (4) or ulcera~fi,ng stenosi,ng type (4). Histology of biopsie.s from the tumor ~n~ from the surrou,nding Barrett epi.theli~tm revealed a poorly/modera,t,e differentiated
adenocarcinoma.
The junctional type epithelium was present in all patients with moderate to severe dysplastic changes in alil biopsies. Th.e~re dysplastic c h ~ g e s we,re obser-
ved in just over half of the biopsies containing the specialized columnar epithelium and not in the gas- tric fundic type epithelium. These results were compared with the histological findings in 200 fiber- endoscopical Barrett esophagus biopsies of 50 pa- tients without malignancy. Dysplastic changes were observed in 18 % of the biopsy material : in 16 % in junctional type and in 2 % in specialized co- lumnar epithelium. The results of these light mi- croscopic fi,ndings correspond ~to the fi, rst prelimiaa,ary resul.ts of an ongoing cell proli.feraiion study w~th au~orad.i,ography of biopsies t akea~ from the area around a Barrett carcinoma which often show ex- pan.simon of the prol.ife,rative compartment in the junction'al type, only sporadically i~n the specialized c~.lum,n~r type and not in, ,the gastric fundic type epi,thelivm.
R~SUMI~
14 patients porteurs d'addnocarcinome oesophagien entourd de muqueuse de type cylindrique (Barrett) ont ~td investigu~s sur le plan clinique, endoseopique et ont s soumis h une ~tude histologique sp~ciale des'tinge d caract~riser l'environnement muqueux de eette ls maligne. Pratiquement t o u s l e s patients se plaignaient de dysphagie, de perte ponddrale et avaient pr~,~ent~ ant~rieurement des sympt6mes de reflux gastro-cesophagien. Les aspects tumoraux ont
~tO variables : envahissement super/iciel (1), crois- sance exophytique (4), multi/ocale (1), ulceration maligne distale (4) ou ulceration st~nosante (4). Les biopsies pr~lev~es au niveau de la tumeur et dam"
I'~pith~lium eylindrique type Barrett environnant ont
r~vs des ad~nocarcinomes peu ou mod~r~ment di[fOrenci~s.
La muqueuse de type cardial (MC) ~tait prs chez t o u s l e s patients avec des degr~s de dysplasie sdvkre ou mod~r~e observes sur toutes les biopsies.
Ces changements dysplasiques ont ~td observes dans un pea plus de la moiti~ des biopsies de muqueuse type cylindrique avec m~taplasie intestinale (MCMI) et manquaient au niveau des muqueuses de type /un- dique (MF). Ces r~sultats ont ~t~ eompards avec les donn~es histologiques de 200 biopsies endoscopiques pr6tev~es ehez 50 patients porteurs d'endobraehy- oesophage sans l~sion maligne. Des changements dys-
Add~'ess for reprints : D" I.C.E. WESDORP, Dep.
Gastroenterology, Andreas Ziekenhuis, T. De Bock- straat 8, 1058 NR Amsterdam (The Netherlands).
Key-words : adenocarcinoma, Ba, rrett's epithelium, dyspl,~i,a, endoscopy, esophagus, esophag~ti~s.
Mots-clks : ad6nocarcinome ces~phagien, dysplasie, endoscopic, 6pi~th61i,um de Barrett, 0esophagi,te.
Acta Endoscopica Tome X I - N ~ 4-5 - 1981 3 1 7
