title: Cytokeratins 7 and 20 and mucin core protein expression in esophageal cervical inlet patch.
abstract: Cervical inlet patch (CIP) is defined by the presence of gastric mucosa within the first few centimeters of the esophagus. Several endoscopic series have demonstrated a frequent association of CIP with Barrett's esophagus (BE) suggesting a pathogenetic link. A histochemical study reporting the presence of acid mucin in CIP, including sulfomucin, supports this hypothesis. We evaluated mucin core protein expression and cytokeratins 7 and 20 (CK7/CK20) pattern in biopsies of CIP, normal antrum, and BE to comment on a possible relationship of CIP with BE. We observed that both lesions have similar cytokeratin patterns with mixed CK7/CK20 reactivity on the surface and pits and lone CK7 positivity in the glands. MUC5AC was strongly expressed on the surface and pits but not in the glands of CIP and antral mucosa. Within BE, MUC5AC positivity was noted not only on the surface and pits but also in the glands. MUC6 similarly decorated the glands of CIP and BE. MUC2 was expressed rarely in CIP with goblet cells but conspicuously on the surface and pits of BE. MUC5B was seen in both CIP and BE and rarely in the antral mucosa. The similarities between CIP and BE but not with normal antral mucosa fits with the hypothesis that both lesions may originate from submucosal esophageal mucous glands. Two pathogenetic pathways can be entertained: focal upper esophageal mucosal misdevelopment in pediatric population and patchy metaplastic replacement of squamous mucosa in adults with gastroesophageal reflux disease.
authors.affiliation: Gastrointestinal Pathology Service, Department of Pathology, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, USA. glauwers@partners.org
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Mari
authors.initials: M
authors.lastname: Mino
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ban
authors.forename: David
authors.initials: D
authors.lastname: Forcione
authors.forename: Desiree E
authors.initials: DE
authors.lastname: Eatherton
authors.forename: Michio
authors.initials: M
authors.lastname: Shimizu
authors.forename: Henri
authors.initials: H
authors.lastname: Sevestre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000378:metabolism / Q000473:pathology; D002828:Choristoma / Q000378:metabolism* / Q000473:pathology; D004935:Esophageal Diseases / Q000378:metabolism* / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa; D006801:Humans; D007150:Immunohistochemistry; D007381:Intermediate Filament Proteins / Q000378:metabolism*; D053554:Keratin-20; D053552:Keratin-7; D007633:Keratins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D055271:Mucin 5AC; D055262:Mucin-2; D009077:Mucins / Q000378:metabolism*; D011706:Pyloric Antrum / Q000378:metabolism / Q000473:pathology
chemical_list: D007381:Intermediate Filament Proteins; C507499:KRT20 protein, human; C507497:KRT7 protein, human; D053554:Keratin-20; D053552:Keratin-7; C524625:MUC2 protein, human; C524678:MUC5AC protein, human; D055271:Mucin 5AC; D055262:Mucin-2; D009077:Mucins; D007633:Keratins