Cases reported "Metaplasia"

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1/14. Heterotopic sebaceous glands in the esophagus: histopathological and immunohistochemical study of a resected esophagus.

    A resected esophagus with numerous heterotopic sebaceous glands was examined in an attempt to determine whether esophageal heterotopic sebaceous glands are the result of a metaplastic process or a congenital anomaly. The present case concerns a 79-year-old Japanese man with numerous esophageal heterotopic sebaceous glands accompanied by superficial esophageal cancer. The resected esophagus possessed numerous heterotopic sebaceous glands, which could be seen clearly as slightly elevated, yellowish lesions. Histological examination of these glands, all of which were located in the lamina propria, revealed lobules of cells that showed characteristic sebaceous differentiation. Bulbous nests of proliferating basal cells showing sebaceous differentiation were occasionally observed in the esophageal epithelium. Of the antibodies against six different keratins used, only anti-keratin 14 labeled both the heterotopic sebaceous glands and the bulbous nests. Acquired metaplastic change of the esophageal epithelium is probably the pathogenetic mechanism involved in these unusual lesions.
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2/14. Rapid progression to high-grade dysplasia in Barrett's esophagus after liver transplantation.

    There is an increased incidence of malignancies in transplant recipients. Accelerated progression from a premalignant lesion to carcinoma has been reported in transplant recipients with skin cancer and colon cancer. Whereas Barrett's esophagus is a common premalignant condition in the normal population, rapid progression to severe dysplasia or carcinoma has not been widely reported in transplant recipients. We report on a liver transplant recipient who developed rapid progression from Barrett's esophagus without dysplasia to high-grade dysplasia within 9 months after transplantation.
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3/14. Recent advances in Barrett's esophagus: short-segment Barrett's esophagus and cardia intestinal metaplasia.

    The recent rapid increase in the incidence of adenocarcinoma of the distal esophagus and the gastric cardia has generated significant interest in the premalignant lesion, Barrett's esophagus. The traditional definition of Barrett's esophagus included the presence of 3 cm or greater of columnar mucosa in the distal esophagus. Studies have clarified that intestinal metaplasia was not only the most common and distinctive type of epithelium detected within the columnar mucosa, but also the one with greatest malignant potential; therefore, Barrett's esophagus has come to be defined by the histological presence of intestinal metaplasia. Previous studies evaluating the association of esophageal adenocarcinoma with Barrett's esophagus have only included patients with traditional or long-segment Barrett's esophagus. However, recent studies have suggested that dysplasia and adenocarcinoma can also be associated with short-segment Barrett's esophagus (SSBE), ie, less than 3 cm of columnar mucosa. Data are also emerging regarding the significance of intestinal metaplasia detected in biopsy specimens obtained immediately below the gastroesophageal junction, ie, from the gastric cardia. However, the premalignant potential of cardia intestinal metaplasia (CIM) is unknown at this time. Although the exact incidence of adenocarcinoma in SSBE is not known, endoscopic surveillance of such patients, although controversial, appears to be prudent at this time. With the currently available information, routine biopsy of a normal-appearing squamocolumnar junction is not advocated. This review critically evaluates and summarizes recent data on SSBE and CIM.
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4/14. Columnar-lined lower esophagus: an acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus with 12 adenocarcinomas.

    The analysis of a series of 1,225 cases of reflux esophagitis shows the serious nature of this condition. A liberal use of antireflux operations therefore seems justified. Extensive columnar metaplasia of the distal esophagus, or columnar-lined lower esophagus (CLLE), represents a late irreversible stage of reflux esophagitis. Repeated esophagoscopies demonstrate the acquired nature of the lesion. It is caused by the progressive healing, from below upward, of peptic ulcerations on the squamous epithelium by metaplasia of columnar mucosa. Antireflux operations stop the progressive ascent of heterotopic epithelium and thus stabilize reflux esophagitis and cure complications such as ulcerations and strictures. The premalignant character of this condition is established by a 10 per cent incidence of adenocarcinomas in a series of 140 cases of extensive columnar metaplasia. The transition toward malignancy seems to be irreversible and cannot be arrested by an antireflux operation. Therefore, repeated esophagoscopic controls and biopsies are an absolute necessity in all cases of extensive columnar metaplasia, even after cure of active reflux esophagitis by Nissen fundoplication.
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5/14. Barrett's esophagus and squamous cell carcinoma in a patient with psychogenic vomiting.

    We report the association of Barrett's esophagus and invasive squamous cell carcinoma of the distal esophagus in a young 31-yr-old woman with a history of self-induced psychogenic vomiting. The development of intestinalized columnar mucosa and esophageal cancer in this young patient illustrates the complicated associations between human behavior and pathogenetic mechanisms involved in esophageal carcinogenesis.
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6/14. Persistent clonal areas and clonal expansion in Barrett's esophagus.

    Three patients with Barrett's esophagus who had cytogenetic abnormalities detected in their metaplastic epithelium developed high-grade dysplasia or adenocarcinoma during prospective surveillance over a period of 1.5 to 6 years. In the 3 cases, cytogenetic abnormalities that were associated with the most advanced histological lesions were present in samples obtained 11, 25, and 48 months prior to the diagnosis of high-grade dysplasia or carcinoma. In a fourth patient, marker chromosomes found in a Barrett's adenocarcinoma were also present in an esophageal region spatially removed from the tumor. In all four patients, clonal cytogenetic abnormalities were present in samples obtained at widespread locations in the Barrett's segment. These observations suggest that in some patients with Barrett's esophagus clonal proliferations arise in regions of benign histology and spread to involve large areas of Barrett's mucosa. These clones persisted when the disease progressed to high-grade dysplasia or adenocarcinoma.
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7/14. A "crackleware" oesophagus.

    This case report describes a 70 year old woman with excessive diffuse keratinisation of the oral cavity and oesophagus harbouring a squamous cell carcinoma. This excessive diffuse keratinisation of normally non-keratinised squamous epithelium could not be identified in normally non-keratinised epithelia in other parts of the body (the vagina), arguing against a genetic basis for this disorder. The term "crackleware" oesophagus was used to describe this entity, which has not been described previously in the English literature.
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8/14. Squamous cell carcinoma of the esophagus with cartilaginous metaplasia at metastatic lesions.

    Subdermal metastatic nodules in a 62-year old male patient with esophageal carcinoma contained both carcinomatous and chondroid areas. The carcinomatous areas showed the histology of poorly differentiated squamous cell carcinoma, and light microscopically an apparent transition could be traced from carcinomatous cells to chondroid cells. In the chondroid cells, the characteristics of chondrocytes were demonstrated by light microscopic, electron microscopic, histochemical and immunohistochemical studies, although nuclear atypism was evident, suggesting their malignancy. Furthermore, immunohistochemical studies showed that some chondroid cells contained both keratin proteins and squamous cell carcinoma antigen, which were also found in the carcinomatous cells. These findings together with the light microscopic observations suggest that chondroid cells are derived from squamous cell carcinoma cells.
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9/14. Barrett's esophagus in a newborn.

    We describe Barrett's esophagus occurring in a 3-week-old male. The finding of columnar cell-lined lower esophageal epithelium in the presence of gastroesophageal reflux supports the theory of an acquired phenomenon and suggests that the metaplastic process may have begun in the perinatal period.
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10/14. New surgical approach to complicated gastroesophageal reflux disease: transthoracic parietal cell vagotomy.

    Surgical treatment of peptic stricture of the esophagus associated with columnar (Barrett) metaplasia can be a difficult problem. Collis-Nissen fundoplication restores an intraabdominal antireflux barrier for most cases of peptic stricture; however, 20% of patients may have persistence of pathological acid reflux. By reducing acidity of postoperative reflux, parietal cell vagotomy may complement nonresectional surgical results for Barrett stricture.
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