What is the role of cytokeratins in Barrett/cardia differentiation?
Department of Pathology, Baylor College of Medicine, Houston, TX 77030, USA.Archives of pathology & laboratory medicine (Impact Factor: 2.84). 03/2005; 129(2):181-2. DOI: 10.1043/1543-2165(2005)129<181:WITROC>2.0.CO;2
The importance of distinguishing between Barrett metaplasia and intestinal metaplasia of the gastric cardia is now accepted, and the management of each entity is quite different. Patients with Barrett metaplasia are enrolled in surveillance programs, consisting of periodic endoscopy and biopsy, because of the known risk of developing adenocarcinoma of the esophagus. Patients with intestinal metaplasia of the gastric cardia, however, are not currently enrolled in such programs, because this condition carries a low risk of developing adenocarcinoma of the gastric cardia. The distinction between both conditions by morphologic examination of routine histologic sections of endoscopic biopsies is extremely difficult if at all possible. A group of investigators proposed the use of immunostains for cytokeratin (CK) 7 and CK20 to overcome such difficulty. They concluded that the Barrett CK7/CK20 pattern was a highly sensitive and specific marker for Barrett metaplasia. Their observations, however, were not confirmed by other investigators. However, because it may be associated with premalignant lesions elsewhere in the gastric mucosa, we propose that intestinal metaplasia of the gastric cardia may have the same clinical implication as Barrett metaplasia.
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ABSTRACT: Dysplasia, or intraepithelial neoplasia, consists of noninvasive neoplastic cellular proliferation that may precede or accompany invasive neoplasia. Diagnosis is mainly based on histological criteria, which include cytological and structural alterations, since macroscopically identifiable lesions often do not occur. In all current classifications, dysplasia is divided in two categories, low- and high-grade, with the aim of attempting to evaluate risk and guide the therapeutic approach. The classification of the Vienna consensus aims to unity criteria and decrease interobserver variability in diagnosis. In the digestive tract, evaluation of epithelial dysplasia is especially important in four entities: Barrett's esophagus, chronic gastritis, inflammatory bowel disease, and colorectal adenomas. The criteria for diagnosis and dysplasia staging are the same in all these entities, but the therapeutic approach may vary according to the affected organ and the clinico-pathological context.Gastroenterología y Hepatología 01/2008; 30(10):602-11. · 0.84 Impact Factor
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ABSTRACT: In contrast to squamous cell carcinomas of the esophagus as well as adenocarcinomas of the distal or middle third of the stomach, the incidence of adenocarcinomas in the distal esophagus or EG junction increased continuously during the last decades. Initially, most of these cancers were thought to represent either esophageal or gastric carcinomas (especially the so-called “carcinomas of the cardia”). However, it became clear that the pathogenesis of these cancers exhibits differences. While most of the “true” adenocarcinomas of the distal esophagus arise predominantly on the basis of Barrett’s metaplasia developing in the clinical setting of gastroesophageal reflux disease, the etiology of cancers of the cardia and the subcardial stomach remained unclear.Recent results in cancer research. Fortschritte der Krebsforschung. Progrès dans les recherches sur le cancer 01/2010; 182:29-38. DOI:10.1007/978-3-540-70579-6_3
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