Malignancy and premalignancy in Barrett's esophagus: a clinical - endoscopical - and histological study

In this study, 14 patients with esophageal adenocarcinoma surrounded by columnar lined (Barrett) epithelium were investigated, to learn more about the clinical, endoscopical and especially histological characteristics of this malignant condition. Nearly all patients complained of dysphagia and weight loss and had experienced reflux symptoms in the past. The macroscopic appearance of the tumors was variable: superficial spreading (1), exophytous growing (4), multifocal (1), distal malignant ulcer (4) or ulcerating stenosing type (4). Histology of biopsies from the tumor and from the surrounding Barrett epithelium revealed a poorly/ moderate differentiated adenocarcinoma. The junctional type epithelium was present in all patients with moderate to severe dysplastic changes in all biopsies. There dysplastic changes were observed in just over half of the biopsies containing the specialized columnar epithelium and not in the gastric fundic type epithelium. These results were compared with the histological findings in 200 fiberendoscopical Barrett esophagus biopsies of 50 patients without malignancy. Dysplastic changes were observed in 18% of the biopsy material: in 16% in junctional type and in 2% in specialized columnar epithelium. The results of these light microscopic findings correspond to the first preliminary results of an ongoing cell proliferation study with autoradiography of biopsies taken from the area around a Barrett carcinoma which often show expansion of the proliferative compartment in the junctional type, only sporadically in the specialized columnar type and not in the gastric fundic type epithelium.