Genesis of Barrett’s Neoplasia: Current Concepts

Surgical and Molecular Pathology of Barrett Esophagus

“…In intramucosal adenocarcinoma, the neoplastic cells are limited to the mucosa ( Fig 5); however, these cells will make their way to the basement membrane and into the muscularis mucosae or the lamina propria, but they do not go beyond this point. 5 Histologically, an effacement of the architecture of the lamina propria can be seen, 28 as well as back-to-back microglands, small clusters, or infiltrating single cells. 56 A syncytial growth pattern may also be observed.…”

“…Tumor cells infiltrate beyond the muscularis mucosa in the setting of invasive adenocarcinoma and oftentimes evoke a desmoplastic reaction. 5 The microscopic pattern is mostly of the intestinal form, however diffuse, and signet ring cell or mixed types can be observed. The tumor cells may produce mucin, and the tumor itself will generally be well to moderately differentiated.…”

“…16 In infants, BE may arise from congenital rests of gastric columnar epithelium reacting to gastroesophageal reflux. 5,17 The way in which normal squamous epithelium transitions into specialized columnar epithelium is not yet clear. 18 However, based on the theory of restitution and replication proposed by Jankowski et al, 19 after the acid-peptic content of the stomach erodes the parabasal and superficial layers of the squamous mucosa ( Fig 1A), the basal progenitor cells move into denuded areas.…”

“…18 However, based on the theory of restitution and replication proposed by Jankowski et al, 19 after the acid-peptic content of the stomach erodes the parabasal and superficial layers of the squamous mucosa ( Fig 1A), the basal progenitor cells move into denuded areas. 5 In the setting of persistent gastroesophageal reflux, these multipotential stem cells become resistant to acid and bile, selectively differentiating into columnar epithelium that secretes mucin ( Fig 1B). 5,19 By contrast, the upward movement of the columnar epithelium from the stomach could cause metaplasia due to wound healing of the ulcerated mucosa.…”

“…5 In the setting of persistent gastroesophageal reflux, these multipotential stem cells become resistant to acid and bile, selectively differentiating into columnar epithelium that secretes mucin ( Fig 1B). 5,19 By contrast, the upward movement of the columnar epithelium from the stomach could cause metaplasia due to wound healing of the ulcerated mucosa. 5…”