RéSUMé
Les applications de l’immunohistochimie et de l’histochimie des mucines à l’étude de l’endobrachyœsophage sont passées en revue et discutées.
Les auteurs ont étudié la population de cellules neuroendocrines présentes dans les couches profondes de l’épithélium de Barrett. La différentiation des cellules endocrines est d’habitude propre au type de muqueuse présente dans l’épithélium de Barrett mais, en cas de dysplasie, cette différentiation peut être aberrante. L’expression cellule neuroendocrine est perdue dans l’adénocarcinome.
Des facteurs régulateurs de croissance, tels que le facteur épidermique de croissance (EGF), le TGF α et le récepteur TGF, ont été identifiés dans l’épithélium de Barrett avec une expression accrue au niveau de la muqueuse métaplasique cylindrique spécialisée de type intestinal. Par méthode immunohistochimique, l’expression des oncogènes ras, myc et fos est rarement mise en évidence dans la muqueuse de Barrett de type gastrique ou jonctionnel mais cette expression est accrue dans l’épithélium intestinal spécialisé et dans la dysplasie. Ces observations plaident pour une potentialité maligne accrue de l’épithélium intestinal de l’endobrachyœsophage.
L’histochimie des mucines de la muqueuse de Barrett est passée en revue. Bien que l’existence de sulphomucines, sans cellules caliciformes sur épithélium spécialisé ait été proposée comme marqueur potentiel de malignité, cette caractéristique n’est pas suffisamment sensible ou spécifique. La cytométrie de flux permet d’identifier une catégorie de patients à risque accru.
La dysplasie, mise en évidence par l’histologie, demeure le meilleur moyen d’identifier les patients à risque de malignité sur endobrachyœsophage. Néanmoins, ces études montrent que l’endobrachyœsophage, caractérisé par son évolution depuis la muqueuse normale jusqu’à la dysplasie et la malignité, constitue un modèle d’étude du processus de transformation maligne et de l’approche de son diagnostic précoce.
Summary
Applications of immunohistochemistry and mutin histochemistry to the study of Barrett’s oesophagus are reviewed and discussed. The neuroendocrine cell population found in the deeper layers of Barrett’s mucosa has been studied. Neuroendocrine cell differentiation usually conforms to the type of mucosa present within Barrett’s mucosa but, in the presence of dysplasia, there may be aberrant differentiation. Neuroendocrine cell expression is lost in adenocarcinoma.
Growth regulatory factors such as epidermal growth factor (EGF), transforming growth factor alpha (TGFa) and EGF receptor have been identified in Barrett’s mucosa with increasing expression in specialized columnar (intestinal) type mucosa. Using immunohistochemistry, expression of ras, myc and fos oncogenes is rarely identified in gastric or junctional type of Barrett’s mucosa but there is increasing expression in specialized columnar (intestinal) epithelium and in dysplasia. These findings may indicate the increased malignant potential of the intestinal type of Barrett’s mucosa.
The mucin histochemistry of Barrett’s mucosa is reviewed. Although appearance of sulphomucin with non- goblet cells of specialized columnar épithélium has been suggested as a marker of potential malignancy, it is not sufficiently sensitive or specific. Flow cytometry may identify patients at increased risk. Dysplasia, identified histologically, remains the most important means of identifying patients at risk of malignancy in Barrett’s oesophagus. However, these studies indicate that Barrett’s oesophagus with its progression from normal mucosa, through dysplasia to malignancy, may prove very useful in the study of the process of malignant transformation and its early detection.
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Ritchie, A.J., Sloan, J.M. Critères histologiques et immunohistochimiques de surveillance de l’endobrachyœsophage. Acta Endosc 22, 531–540 (1992). https://doi.org/10.1007/BF02965116
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DOI: https://doi.org/10.1007/BF02965116
Mots-clés
- cellules neuroendocrines
- endobrachyœsophage
- expression oncogéne
- facteurs de croissance
- histochimie des mucines
- immunohistochimie