Publication: Changing pattern of cytokeratin 7 and 20 expression from normal epithelium to intestinal metaplasia of the
gastric mucosa and gastroesophageal junction
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Date
2002
Authors
Jovanovic, I. ; Tzardi, M. ; Mouzas, I.A. ; Micev, M. ; Pesko, P. ; Milosavljevic, T. ; Zois, M. ; Sgantzos, M. ; Delides, G. ; Kanavaros, Panagiotis
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Publisher
Murcia : F. Hernández
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DOI
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info:eu-repo/semantics/article
Description
Abstract
It is currently unclear whether intestinal
metaplasia at the esophagogastric junction and in the
distal esophagus represent a continuum of the same
underlying disease process, i.e., gastroesophageal reflux,
or constitute different entities with a diff e r e n t
pathogenesis. Biopsies below the Z line might show
specialized epithelium in some patients and the question
is whether this is another form of short segment Barrett’s
esophagus or whether it is related to a generalized
atrophic process of the stomach. Data from recent
studies regarding the expression of cytokeratin CK7 and
CK20 in intestinal metaplasia (IM) found at the
gastroesophageal junction are conflicting.
Prompted by these data we undertook the present
study: a) to evaluate the expression of CK7 and CK20 in
IM of the gastric cardia and to compare the findings with
those in patients with Barrett’s esophagus and IM of the
gastric corpus and antrum mucosa; and b) to evaluate the
immunophenotype of non-intestinalized cardiac mucosa
and to compare it with that of normal gastric epithelium.
We studied the expression of CK7 and CK20 on
biopsy specimens from patients with long-seg m e n t
B a r r e t t ’s esophagus (n=17) and surgical resection and
biopsy specimens of gastric cardia (n=15), corpus (n=14)
and antrum (n=22) from patients with histological evidence of IM. Eighty-four biopsy specimens from 42
patients (antrum n=15, corpus n=20, cardia n=7) without
evidence of IM were studied as a control group.
We observed an immunophenotype characterised by
diffuse moderate to strong CK7 staining on the surface
and crypt epithelium combined with strong CK20
staining on the surface and superficial part of the crypts
in 94.1% (16/17) of the cases with long-se g m e n t
Barrett’s esophagus, but in none of the 36 cases with IM in distal stomach (antrum and corpus). IM in the gastric
cardia expressed the immunophenotype seen in IM of
the gastric mucosa in 93.3% (14/15) of the cases. On the
other hand, normal cardiac epithelium expressed patchy
strong CK7 staining on the surface epithelium and on
both, superficial and deep parts of the pits combined
with patchy strong CK20 staining on the surf a c e
epithelium and superficial pits, a feature permitting
distinction of the normal cardiac epithelium from those
of the normal gastric antrum and corpus epithelium.
We conclude that the expression of cy t o keratins 7
and 20 can be used to distinguish the origin of IM of the
gastroesophageal junction. The CK7/20
immunophenotype of IM in the gastric cardia closely
resembles that of the IM in the gastric antrum and corpus
and is different from IM in long-segment Barrett's
esophagus. In contrast, the CK7/20 immunophenotype of
the cardiac epithelium is different from that of the gastric
antrum and corpus mucosa, suggesting that cardiac
epithelium might not be a native normal g a s t r i c
epithelium but one that is acquired as a consequence of
longstanding inflammation. Changing pattern of CK7
and CK20 expression from normal to intestinalized
epithelium suggests that IM arising from cardiac
epithelium might have distinctive features.
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