Histopathology of Early Neoplasia in Barrett’s Esophagus

  • Jeremy R. Jass


The evolution of early epithelial neoplasia in the lower esophagus occurs in three principal stages. Inflammation and ulceration due to chemical irritation caused by gastroesophageal reflux results in replacement of the squamous epithelium of the lower esophagus by a columnar epithelium showing intestinal differentiation. The columnar epithelial lining, or Barrett’s esophagus, is classified as the long type when the segment is ≥3 cm or the short type when the length is <3 cm. The second stage is the development of focal or multifocal intraepithelial neoplasia (dysplasia) within Barrett’s esophagus. The final stage is the emergence of an invasive (malignant) subclone spreading sequentially into lamina propria, muscularis mucosae, and submucosa. From the diagnostic perspective, critical issues are the diagnosis of Barrett’s esophagus, the distinction between reactive change and unequivocal intraepithelial neoplasia, and the recognition of high-grade intraepithelial neoplasia requiring surgical intervention.


Goblet Cell Intestinal Metaplasia Endoscopic Mucosal Resection Intraepithelial Neoplasia Neoplastic Change 
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  1. 1.
    Endo T, Tamaki K, Arimura Y, et al (1998) Expression of sulfated carbohydrate chain and core peptides of mucin detected by monoclonal antibodies in Barrett’s esophagus and esophageal adenocarcinoma. J Gastroenterol 33:811–815PubMedCrossRefGoogle Scholar
  2. 2.
    Labouvie C, Machado JC, Carneiro F, et al (1999) Differential expression of mucins and trefoil peptides in native epithelium, Barrett’s metaplasia and squamous cell carcinoma of the oesophagus. J Cancer Res Clin Oncol 125:71–76PubMedCrossRefGoogle Scholar
  3. 3.
    Jass JR (1981) Mucin histochemistry of the columnar epithelium of the oesophagus: a retrospective study. J Clin Pathol 34:866–870PubMedCrossRefGoogle Scholar
  4. 4.
    Voutilainen M, Färkkilä M, Juhola M, et al (1999) Complete and incomplete intestinal metaplasia at the oesophagogastric junction: prevalences and associations with endoscopic erosive oesophagitis and gastritis. Gut 45:644–648PubMedCrossRefGoogle Scholar
  5. 5.
    Takubo K, Nixon JM, Jass JR (1995) Ducts of esophageal glands proper and Paneth cells in Barrett’s esophagus: frequency in biopsy specimens. Pathology 27:315–317PubMedCrossRefGoogle Scholar
  6. 6.
    Takubo K, Sasajima K, Yamashita K, et al (1991) Double muscularis mucosae in Barrett’s esophagus. Hum Pathol 22:1158–1161PubMedCrossRefGoogle Scholar
  7. 7.
    Eads CA, Lord RV, Kurumboor SK, et al (2000) Fields of aberrant CpG island hypermethylation in Barrett’s esophagus and associated adenocarcinoma. Cancer Res 60:5021–5026PubMedGoogle Scholar
  8. 8.
    Ormsby AH, Goldblum JR, Rice TW, et al (1999) Cytokeratin subsets can reliably distinguish Barrett’s esophagus from intestinal metaplasia of the stomach. Hum Pathol 30:288–294PubMedCrossRefGoogle Scholar
  9. 9.
    Thurberg BL, Duray PH, Odze RD (1999) Polypoid dysplasia in Barrett’s esophagus: a clinicopathologic, immunohistochemical, and molecular study of five cases. Hum Pathol 30:745–752PubMedCrossRefGoogle Scholar
  10. 10.
    Schlemper RJ, Itabashi M, Kato Y, et al (1997) Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists. Lancet 349:1725–1729PubMedCrossRefGoogle Scholar
  11. 11.
    Lewin KJ, Appelman HD (1996) Atlas of Tumor Pathology. Tumors of the Esophagus and Stomach. AFIP, Washington, DCGoogle Scholar
  12. 12.
    Khan S, Do K-A, Kuhnert P, et al (1998) Diagnostic value of p53 immunohistochemistry in Barrett’s esophagus: an endoscopic study. Pathology 30:136–140PubMedCrossRefGoogle Scholar
  13. 13.
    Reid BJ, Weinstein WM, Lewin KJ, et al (1988) Endoscopic biopsy can detect high-grade dysplasia or early adenocarcinoma in Barrett’s esophagus without grossly recognizable neoplastic lesions. Gastroenterology 94:81–90PubMedGoogle Scholar
  14. 14.
    Rubio CA, Riddell R (1988) Musculo-fibrous anomaly in Barrett’s mucosa with dysplasia. Am J Surg Pathol 12:885–889PubMedCrossRefGoogle Scholar
  15. 15.
    Schlemper RJ, Kato Y, Stolte M (2000) Diagnostic criteria for gastrointestinal carcinomas in Japan and Western countries: proposal for a new classification system of gastrointestinal epithelial neoplasia. J Gastroenterol Hepatol 15(suppl):C52–C60Google Scholar

Copyright information

© Springer Japan 2002

Authors and Affiliations

  • Jeremy R. Jass
    • 1
  1. 1.Department of PathologyUniversity of Queensland School of MedicineHerstonAustralia

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