Barrett's oesophagus: from metaplasia to dysplasia and cancer

Abstract

Barrett's oesophagus is a premalignant condition that predisposes to the development of oesophageal adenocarcinoma. It is detected on endoscopy and confirmed histologically by the presence in the lower oesophagus of a metaplastic mucosa, the so-called specialised epithelium, which resembles incomplete intestinal metaplasia in the stomach. These similarities with incomplete intestinal metaplasia are present on histology, mucin histochemistry, and immunohistochemistry with various differentiation markers (cytokeratins and MUC antigens). On morphology, the carcinogenetic process of Barrett's mucosa progresses through increasing grades of epithelial dysplasia. Dysplasia, a synonym of intraepithelial neoplasia, is the only marker that can be used at the present time to delineate a population of patients at high risk of cancer. Among the numerous molecular events that have been shown to play a role in the neoplastic transformation of Barrett's mucosa, only changes in DNA ploidy, increased proliferation, and alterations of the p53 gene have been suggested to be of potential help in the surveillance of patients.

Figure 1

Barrett's mucosa with incomplete intestinal metaplasia (specialised mucosa). The epithelium is composed of goblet cells interspersed between intermediate mucous cells, both in the surface and glandular epithelium (haematoxylin–eosin, original magnification x400).

Figure 2

Dysplasia in Barrett's mucosa, with both architectural and cytological abnormalities of low grade (A) and high grade (B) (haematoxylin–eosin, original magnification x400).