Changing pattern of cytokeratin 7 and 20 expression from normal epithelium to intestinal metaplasia of the gastric mucosa and gastroesophageal junction
Changing pattern of cytokeratin 7 and 20 expression from normal epithelium to intestinal metaplasia of the gastric mucosa and gastroesophageal junction
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DOI：
10.14670/hh-17.445
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发表时间：
2002-04-01
影响因子：
2
通讯作者：
Kanavaros, P
中科院分区：
文献类型：
--
作者：
Jovanovic, I;Tzardi, M;Kanavaros, P
目前尚不清楚食管胃交界处和食管远端的肠上皮化生是否代表相同基础疾病过程的连续体，即，胃食管反流，或构成不同的实体与不同的发病机制。Z线以下的活检可能显示某些患者的特化上皮，问题是这是否是另一种形式的短节段Barrett食管，或者是否与胃的广泛萎缩过程有关。近年来关于细胞角蛋白CK 7和CK 20在胃食管交界处肠上皮化生（intestinal metaplasia，IM）中表达的研究结果存在争议，鉴于此，我们进行了以下研究：（1）检测CK 7和CK 20在贲门IM中的表达，并与Barrett's食管、胃体和胃窦IM患者的结果进行比较;（B）观察17例长节段Barrett食管患者和15例贲门手术切除活检标本中CK 7和CK 20的表达，并与正常胃粘膜进行比较。体部（n=14）和胃窦（n=22）的IM的组织学证据的患者。来自42名患者的84份活检标本（窦n=15，体n=20，结果发现，94.1%（16/17）的长型肠梗阻患者的免疫表型为肠上皮细胞表面弥漫性中强CK 7染色，肠上皮细胞表面和浅表部分呈CK 20强染色。36例远端胃（胃窦和胃体）IM均为阴性。93.3%（14/15）的贲门IM表达胃粘膜IM的免疫表型。另一方面，正常心脏上皮在表面上皮和小凹的浅部和深部表达斑片状强CK 7染色，并在表面上皮和浅小凹上表达斑片状强CK 20染色，我们的结论是，细胞角蛋白7和20的表达可以使正常的心脏上皮细胞与正常的胃窦和胃体上皮细胞区别开来。可用于鉴别胃食管交界处IM的起源。贲门IM的CK 7/20免疫表型与胃窦和胃体IM的CK 7/20免疫表型非常相似，与长节段Barrett食管IM不同。与此相反，CK 7/20免疫表型的心脏上皮细胞是从胃窦和胃体粘膜不同，这表明心脏上皮细胞可能不是一个天然的正常胃上皮细胞，而是一个收购作为长期炎症的结果。CK 7和CK 20表达从正常到钙化上皮的变化模式表明，心肌上皮产生的IM可能具有独特的特征。
It is currently unclear whether intestinal metaplasia at the esophagogastric junction and in the distal esophagus represent a continuum of the same underlying disease process, i.e., gastroesophageal reflux, or constitute different entities with a different pathogenesis. Biopsies below the Z line might show specialized epithelium in some patients and the question is whether this is another form of short segment Barrett's esophagus or whether it is related to a generalized atrophic process of the stomach. Data from recent studies regarding the expression of cytokeratin CK7 and CK20 in intestinal metaplasia (IM) found at the gastroesophageal junction are conflicting.Prompted by these data we undertook the present study: a) to evaluate the expression of CK7 and CK20 in IM of the gastric cardia and to compare the findings with those in patients with Barrett's esophagus and IM of the gastric corpus and antrum mucosa; and b) to evaluate the immunophenotype of non-intestinalized cardiac mucosa and to compare it with that of normal gastric epithelium.We studied the expression of CK7 and CK20 on biopsy specimens from patients with long-segment Barrett's esophagus (n=17) and surgical resection and biopsy specimens of gastric cardia (n=15), corpus (n=14) and antrum (n=22) from patients with histological evidence of IM. Eighty-four biopsy specimens from 42 patients (antrum n=15, corpus n=20, cardia n=7) without evidence of IM were studied as a control group.We observed an immunophenotype characterised by diffuse moderate to strong CK7 staining on the surface and crypt epithelium combined with strong CK20 staining on the surface and superficial part of the crypts in 94.1% (16/17) of the cases with long-segment Barrett's esophagus, but in none of the 36 cases with IM in distal stomach (antrum and corpus). IM in the gastric cardia expressed the immunophenotype seen in IM of the gastric mucosa in 93.3% (14/15) of the cases. On the other hand, normal cardiac epithelium expressed patchy strong CK7 staining on the surface epithelium and on both, superficial and deep parts of the pits combined with patchy strong CK20 staining on the surface epithelium and superficial pits, a feature permitting distinction of the normal cardiac epithelium from those of the normal gastric antrum and corpus epithelium.We conclude that the expression of cytokeratins 7 and 20 can be used to distinguish the origin of IM of the gastroesophageal junction. The CK7/20 immunophenotype of IM in the gastric cardia closely resembles that of the IM in the gastric antrum and corpus and is different from IM in long-segment Barrett's esophagus. In contrast, the CK7/20 immunophenotype of the cardiac epithelium is different from that of the gastric antrum and corpus mucosa, suggesting that cardiac epithelium might not be a native normal gastric epithelium but one that is acquired as a consequence of longstanding inflammation. Changing pattern of CK7 and CK20 expression from normal to intestinalized epithelium suggests that IM arising from cardiac epithelium might have distinctive features.