title: Goblet cell mimickers in esophageal biopsies are not associated with an increased risk for dysplasia.
abstract: 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.
authors.affiliation: Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. myounes@bcm.edu
authors.forename: Mamoun
authors.initials: M
authors.lastname: Younes
authors.forename: Atilla
authors.initials: A
authors.lastname: Ertan
authors.forename: Gulchin
authors.initials: G
authors.lastname: Ergun
authors.forename: Ray
authors.initials: R
authors.lastname: Verm
authors.forename: Margaret
authors.initials: M
authors.lastname: Bridges
authors.forename: Karen
authors.initials: K
authors.lastname: Woods
authors.forename: Frank
authors.initials: F
authors.lastname: Meriano
authors.forename: A Carl
authors.initials: AC
authors.lastname: Schmulen
authors.forename: Ronald
authors.initials: R
authors.lastname: Colman
authors.forename: Craig
authors.initials: C
authors.lastname: Johnson
authors.forename: Alberto
authors.initials: A
authors.lastname: Barroso
authors.forename: Jim
authors.initials: J
authors.lastname: Schwartz
authors.forename: John
authors.initials: J
authors.lastname: McKechnie
authors.forename: Juan
authors.initials: J
authors.lastname: Lechago
mesh_terms: 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*