PANCREATIC METAPLASIA IN BARRETTS-ESOPHAGUS - AN IMMUNOHISTOCHEMICAL STUDY
PANCREATIC METAPLASIA IN BARRETTS-ESOPHAGUS - AN IMMUNOHISTOCHEMICAL STUDY
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DOI：
10.1097/00000478-199510000-00007
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发表时间：
1995-10-01
影响因子：
5.6
通讯作者：
DAYAL, Y
中科院分区：
文献类型：
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作者：
KRISHNAMURTHY, S;DAYAL, Y
虽然在慢性胃炎患者的胃粘膜中观察到胰化生，但在异位胃粘膜中尚未发现胰化生。我们在 120 名 Barrett 食管患者的 350 份 Barrett 粘膜活检样本中的 11 份中发现了类似胰腺腺泡细胞 (CPAC) 的局灶性细胞簇，这些患者参与了奥美拉唑与雷尼替丁治疗胃食管反流病的临床疗效试验。还研究了我们手术档案中的另外三个病例。所有 14 例的 CPAC 中均存在胰蛋白酶和胰凝乳蛋白酶的免疫反应性，而 13 例中的 12 例中的 ol-淀粉酶和脂肪酶染色均呈阳性。CPAC 中的少数细胞还对 chomogranin（13 例中的 12 例）、血清素（13 例中的 7 例）、生长抑素（12 例中的 3 例）、胃泌素（12 例中的 4 例）呈阳性。 11）和胰多肽（13 中的两个）。没有看到胰岛素或胰高血糖素染色。在一例病例中进行的超微结构研究显示了 CPAC 细胞中胰腺外分泌和内分泌（PP 型）细胞的特征。这些结果共同表明，CPAC 是真正的胰腺腺泡细胞与一些内分泌细胞的聚集体。巴雷特粘膜中的这种胰腺实质很可能是化生起源，并且可能源自移行区细胞或食管粘膜中的多能干细胞或粘液细胞的化生。虽然巴雷特食管中胰化生的发展似乎与药物治疗无关，但这一独特的组织学发现的临床相关性需要进一步研究。
While pancreatic metaplasia has been observed in gastric mucosa of patients with chronic gastritis, it has not been described in ectopic gastric mucosa. We have identified focal clusters of cells resembling pancreatic acinar cells (CPACs) in 11 of 350 biopsies of Barrett's mucosa from 120 patients with Barrett's esophagus enrolled in a clinical efficacy trial of omeprazole versus ranitidine for treatment of gastroesophageal reflux disease. Three additional cases from our surgical files were also studied. Immunoreactivity for trypsin and chymotrypsin was present in the CPACs of all 14 cases, while stains for ol-amylase and lipase were each positive in 12 of 13. A few cells in the CPACs were also positive for chomogranins (12 of 13 cases), serotonin (seven of 13 cases), somatostatin (three of 12), gastrin (four of 11), and pancreatic polypeptide (two of 13). No staining was seen for insulin or glucagon. Ultrastructural studies performed in one case showed features of pancreatic exocrine and endocrine (PP-type) cells in cells within CPACs. These results collectively indicate that the CPACs are aggregates of true pancreatic acinar cells admired with a few endocrine cells. This pancreatic parenchyma in Barrett's mucosa is most Likely of metaplastic origin and could be derived from the transitional zone cells or from pluripotent stem cells in the esophageal mucosa or from metaplasia of mucus cells. While the development of pancreatic metaplasia in Barrett's esophagus appears to be unrelated to drug therapy, the clinical relevance of this distinctive histological finding needs further investigation.