title: Ductal metaplasia in oesophageal submucosal glands is associated with inflammation and oesophageal adenocarcinoma.
abstract: OBJECTIVE
  Recent studies have suggested that oesophageal submucosal gland (ESMG) ducts harbour progenitor cells that may contribute to oesophageal metaplasia. Our objective was to determine whether histological differences exist between the ESMGs of individuals with and without oesophageal adenocarcinoma (EAC).
  
  
  RESULTS
  We performed histological assessment of 343 unique ESMGs from 30 control patients, 24 patients with treatment-naïve high-grade columnar dysplasia (HGD) or EAC, and 23 non-EAC oesophagectomy cases. A gastrointestinal pathologist assessed haematoxylin and eosin-stained ESMG images by using a scoring system that assigns individual ESMG acini to five histological types (mucous, serous, oncocytic, dilated, or ductal metaplastic). In our model, ductal metaplastic acini were more common in patients with HGD/EAC (12.7%) than in controls (3.5%) (P = 0.006). We also identified greater proportions of acini with dilation (21.9%, P < 0.001) and, to a lesser extent, ductal metaplasia (4.3%, P = 0.001) in non-EAC oesophagectomy cases than in controls. Ductal metaplasia tended to occur in areas of mucosal ulceration or tumour.
  
  
  CONCLUSIONS
  We found a clear association between ductal metaplastic ESMG acini and HGD/EAC. Non-EAC cases had dilated acini and some ductal dilation. Because ESMGs and ducts harbour putative progenitor cells, these associations could have significance for understanding the pathogenesis of EAC.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC, USA.|Duke Cancer Institute, Duke University, Durham, NC, USA.|Durham Veterans Affairs Medical Center, Duke University, Durham, NC, USA.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Garman
authors.affiliation: Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC, USA.
authors.forename: Leandi
authors.initials: L
authors.lastname: Kruger
authors.affiliation: Department of Medicine and Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC, USA.
authors.forename: Marzena
authors.initials: M
authors.lastname: Swiderska-Syn
authors.affiliation: Department of Medicine and Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Barry K
authors.initials: BK
authors.lastname: Moser
authors.affiliation: Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC, USA.|Duke Cancer Institute, Duke University, Durham, NC, USA.
authors.forename: Anna Mae
authors.initials: AM
authors.lastname: Diehl
authors.affiliation: Duke Cancer Institute, Duke University, Durham, NC, USA.|Department of Pathology, Duke University, Durham, NC, USA.
authors.forename: Shannon J
authors.initials: SJ
authors.lastname: McCall
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology* / Q000601:surgery; D008297:Male; D008679:Metaplasia / Q000473:pathology / Q000601:surgery; D008875:Middle Aged
keywords: Barrett's oesophagus; ductal metaplasia; oesophageal neoplasm; oesophageal submucosal gland; oesophagus
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