METAPLASTIC COLUMNAR CELLS IN BARRETTS-ESOPHAGUS - A COMMON AND NEGLECTED CELL-TYPE

Goblet cells are considered by most to be a prerequisite for the diagn osis of Barrett's esophagus. Columnar cells that are alcian blue (AB) positive (as are goblet cells) are commonly observed in the surface ep ithelium of Barrett's esophagus, but their distribution in relation to goblet cells has not previously been defined. The authors analyzed th e prevalence and distribution of these cell types in the surface but n ot pit epithelium (where they may sometimes be present in normal gastr ic mucosa). The distribution of the AB-positive columnar cells was map ped out in the entire mucosa of nine esophagectomy specimens, resected for Barrett's-associated high-grade dysplasia or carcinoma, and compa red with other cell types, especially goblet cells. AB-positive goblet and columnar cells were present in 87.1% +/- 5.6% and 85.7% +/- 5.9%, respectively, of the evaluated sections of Barrett's mucosa, whereas gastric-type, AB-negative cells were observed in 46.3% +/- 8.7% of the sections. In 53% of the sections, the surface epithelium contained mo re than 25% AB-positive cells, and in more than three quarters of thes e sections, AB-positive columnar cells were the dominant AB-positive c ell type. No difference in the distribution of the AB-positive epithel ial cells was noticed between the proximal and distal halves of the Ba rrett's mucosae. In the cardia region, seven of nine cases showed a fe w scattered AB-positive columnar cells, and five of nine cases showed a few scattered goblet cells. No AB-positive cells were found in fundi c gland mucosa. These findings indicate that the metaplastic AB-positi ve columnar cells are more prevalent than goblet cells. They may be an alogous to incomplete metaplastic cells of the stomach, and, therefore , their role in the development of neoplasia needs further study. Copy right (C) 1996 by W.B. Saunders Company