Non-goblet cell glandular structures underneath non-island squamous epithelium in columnar line esophagus on endoscopic tissues: Frequencies, forms, associations, and epithelial and mucinous characteristics

Abstract

Hacer Ece Arslan

Objective: Barrett’s esophagus (BE) may possess variable cell lineages, leading to different phenotypes. Unusual glandular forms are currently being considered by some authors as important structures in the development of BE. The aim of this study is to analyze the frequencies, patterns, forms, and epithelial and mucinous characteristics of non-goblet cell glandular structures residing underneath the usual non-island squamous epithelium. Materials and Methods: Endoscopic biopsy tissues and reports of 299 cases with non-dysplastic and non-cancerous histology were examined and analyzed retrospectively. The cases were grouped according to their histopathological and endoscopic diagnosis and the presence of hiatus hernia. 6-8 serial tissue sections were obtained and stained with hematoxylin and eosin and alcian blue/periodic acidSchiff (pH 2.5). The sections were examined under light microscope. Results: Abnormal glandular structures, which were deemed atypical for normal adult esophageal mucosa, were detected in the specimens. These abnormal patterns were grouped as esophageal glands proper and/or ducts-like (n = 141), island of ectopic gastric mucosal-like (n = 73), and dilated-hybrid glands-like (n = 114). Independent of hiatus hernia positivity, these structures were more frequent in columnar line esophagus cases than in chronic esophagitis group. Tall cell epithelium with light purple/purple-blue mucinous content was the most frequently observed type in these structures. Conclusions: Non-goblet cell glandular elements residing underneath the usual non-island esophageal squamous epithelium, whether isolated or forming a unit bearing immature properties, should be considered as metaplastic precursors and interpreted histopathologically as BE.