Abstract
Reflux of gastric contents is the most important factor contributing to the development of a columnar-lined esophagus (CLE). CLE should be considered a “mosaic” of cells, glands, and architectural types showing variable degrees of maturation towards intestinal and gastric epithelium. Dysplasia refers to an unequivocally neoplastic alteration in the epithelium. High-grade (severe) dysplasia consists of neoplastic cellular and/or architectural changes within the columnar epithelium, without invasion through the basement membrane. The prevalence of dysplasia is usually 5% to 10%. Dysplasia has been found in the vast majority in the specialized columnar-type or intestinal-type epithelium. Adenocarcinoma in CLE is most often seen in males. At the time of diagnosis transmural tumor infiltration is found in 60% to 88% of patients, and lymph node invasion in 55% to 74% of patients. The prognosis is poor with a low 5 year survival. Estimates of incidence of cancer vary from 1 case per 52 patient years of follow-up to 1 case per 441 patient years of follow-up.
Résumé
Le reflux du contenu gastrique est le facteur le plus important qui contribue au développement de l'endobrachyoesophage. L'endobrachyoesophage pourrait être considéré comme une “mosaīque” de cellules, de glandes et types d'architectures, présentant des degrés variables de maturation vers l'épithélium intestinal et gastrique. La dysplasie consiste en une altération néoplasique indiscutable de l'épithélium. Une dysplasie sévére (de grade élevé) comporte des cellules néoplasique et/ou des modifications architecturales de l'épithélium cylindrique sans franchissement de la membrane basale. La prévalence de la dysplasie est habituellement de l'ordre de 5 à 10%. La dysplasie est, dans la majorité des cas, mise en évidence dans l'épithélium cylindrique ou intestinal. L'adénocarcinome au sein de l'endobrachyoesophage est retrouvé principalement chez l'homme. Au moment du diagnostic, une infiltration tumorale transpariétale est retrouvée dans 60 á 88% des cas, et un envahissement ganglionnaire dans 55 à 74% des cas. Le pronostic est mauvais avec un taux faible de survié à 5 ans. L'estimation de l'incidence de cancer est variable, allant de 1 cas sur 52 á 1 cas sur 441 patients par année de suivi.
Resumen
El reflujo del contenido gástrico es el factor más importante en el desarrollo del esófago de Barret. El esófago de Barrett debe ser considerado como un “mosaico” de células, glándulas y tipos arquitectónicos, que exhiben grados variables de maduración hacia el epitelio intestinal y gastrico. El termino displasia se refiere a una inequívoca alteracion neoplásica del epitelio. El alto grado (severo) de displasia consistente en cambios celulares neoplásicos y/o arquitectónicos del epitelio columnar, sin invasión de la membrana basal. La incidencia de la displasia es usualmente del orden de 5–10%. La displasia ha sido hallada principalmente en el epitelio del tipo columnar especializado o intestinal. El adenocarcinoma en el esófago de Barrett se observa principalmente en hombres. En el momento del diagnóstico la infiltración transmural del tumor se encuentra con una incidencia de 60–88%, y la invasión de nódulos linfáticos con incidencia de 55–74% de los casos. El pronóstico es pobre, on baja posibilidad de sobrevida a 5 años. La incidencia estimada de cáncer varía desde 1 caso por 52 a 1 caso por 441 pacientes año de seguimiento.
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Tytgat, G.N.J., Hameeteman, W. The neoplastic potential of columnar-lined (Barrett's) esophagus. World J. Surg. 16, 308–312 (1992). https://doi.org/10.1007/BF02071538
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DOI: https://doi.org/10.1007/BF02071538