Nonadenomatous Dysplasia in Barrett Esophagus: A Clinical, Pathologic, and DNA Content Flow Cytometric Study.

Rucker-Schmidt, RL and Sanchez, Carissa A and Blount, PL and Ayub, K and Li, Xiaohong and Rabinovitch, PS and Reid, BJ and Odze, RD (2009) Nonadenomatous Dysplasia in Barrett Esophagus: A Clinical, Pathologic, and DNA Content Flow Cytometric Study. The American journal of surgical pathology, 33 (6). pp. 886-893. ISSN 1532-0979

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Abstract

Rarely, dysplasia in Barrett's esophagus (BE) is composed of crypts lined by cuboidal-shaped cells that contain a centrally located nucleus, markedly increased nuclear/cytoplasmic ratio, but without nuclear stratification characteristic of conventional "adenomatous" dysplasia. The aim of this study was to evaluate the clinical and pathologic features, natural history, and DNA content flow cytometric abnormalities of BE patients with non-adenomatous dysplasia (NAD) in a cohort of BE patients enrolled in a prospective surveillance program. Eighteen patients with NAD identified over a 6 year period, in a cohort of 270 consecutive patients with BE and without esophageal adenocarcinoma (EA) at baseline, were evaluated for clinical and pathologic features, including association with conventional adenomatous dysplasia and EA, DNA content flow cytometric abnormalities (tetraploidy and aneuploidy) and outcome, over a mean follow-up period of 4.1 years. The findings in the 18 study patients were compared to those in the 252 remaining (control) patients without NAD. Control patients included 228 with metaplasia/indefinite for dysplasia, and 24 with conventional adenomatous dysplasia (13 low-grade, 11 high-grade). The prevalence rate of NAD in our BE cohort was 6.7% Of the 18 study patients, there were 17 were males and 1 female of mean age 66.7 years. The mean length of BE was 3.9 cm NAD foci were associated with goblet or non-goblet epithelium in 62% and 38% of cases, respectively. Ninety-four percent of patients with NAD (17/18) also had conventional adenomatous dysplasia (four with low-grade, 13 with high-grade) elsewhere in the esophagus at the same endoscopic procedure as the one that detected NAD. Patients with NAD had a significantly shorter length of BE compared to control patients with conventional adenomatous dysplasia (N=24) (p=0.03). Patients with NAD also showed a significantly higher rate of DNA content flow cytometric abnormalities compared to the entire cohort of control patients (38% vs. 11%, p=0.05). However, no significant differences regarding either flow cytometric abnormalities or progression to EA were found when the NAD patients were compared only to the 24 controls with conventional adenomatous dysplasia. NAD is a high grade histologic variant of intraepithelial neoplasia that is episodic in nature, and shows a high association with conventional adenomatous high-grade dysplasia.

Item Type:	Article or Abstract
Additional Information:	This is a non-final version of an article published in final form in The American Journal of Surgical Oncology, 2009 Jun;33(6):886-93. This article is available to subscribers only vie the URL above.
DOI:	10.1097/PAS.0b013e318198a1d4
PubMed ID:	19194279
NIHMSID:	NIHMS110013
PMCID:	PMC2702161
Grant Numbers:	P01 CA91955
Keywords or MeSH Headings:	Adenocarcinoma/epidemiology Adenocarcinoma/pathology Aged Barrett Esophagus/genetics* Barrett Esophagus/pathology* Disease Progression Esophageal Neoplasms/epidemiology Esophageal Neoplasms/pathology Female Flow Cytometry Humans Male Metaplasia/epidemiology Metaplasia/pathology Prevalence Risk Factors
Subjects:	Diseases > Solid tumors > Digestive system cancer Research Methodologies > Histology
Depositing User:	Library Staff
Date Deposited:	07 May 2009 22:37
Last Modified:	14 Feb 2012 14:42
URI:	http://authors.fhcrc.org/id/eprint/283

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