Goblet cell mimickers in esophageal biopsies are not associated with an increased risk for dysplasia.
BACKGROUND
Identification of intestinal-type goblet cells (ITGCs) in hematoxylin-eosin-stained sections of esophageal biopsies is essential for the diagnosis of Barrett metaplasia. However, we have seen cases diagnosed as Barrett metaplasia based solely on cells that pose morphologic similarity to ITGCs on hematoxylin-eosin staining or stain positive with Alcian blue.


OBJECTIVE
To determine the clinical significance of goblet cell mimickers.


METHODS
Initial biopsies from 78 patients with original diagnosis of Barrett metaplasia negative for dysplasia and a mean follow-up of 72 months were reviewed and reclassified into 3 categories: (1) ITGCs, (2) goblet cell mimickers, or (3) neither. Sections from available paraffin blocks were stained with Alcian blue at pH 2.5. The presence of the different types of cells and positive Alcian blue staining were correlated with each other and evaluated for their significance as predictors of progression to dysplasia.


RESULTS
Goblet cell mimickers were present in 35 cases and were associated with ITGCs in the same biopsy in 23 (66%) of these cases. Intestinal-type goblet cells were present in 56 cases, and the remaining 10 cases, although called Barrett on the original report, did not show either ITGCs or goblet cell mimickers. Only the presence of ITGCs was associated with significant risk for dysplasia (P = .008). Positive Alcian blue staining was not associated with a significant risk for dysplasia.


CONCLUSIONS
Our results indicate that the diagnosis of Barrett metaplasia should be rendered with confidence only when ITGCs are identified on routine hematoxylin-eosin-stained sections.
Younes
Mamoun
M
Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. myounes@bcm.edu
Ertan
Atilla
A
Ergun
Gulchin
G
Verm
Ray
R
Bridges
Margaret
M
Woods
Karen
K
Meriano
Frank
F
Schmulen
A Carl
AC
Colman
Ronald
R
Johnson
Craig
C
Barroso
Alberto
A
Schwartz
Jim
J
McKechnie
John
J
Lechago
Juan
J
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000145:classification / Q000473:pathology*; D001706:Biopsy; D018450:Disease Progression; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D020397:Goblet Cells / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*