Nature and significance of cells with irregular nuclear contours in esophageal mucosal biopsies

Esophageal mucosal biopsies from patients with upper gastrointestinal symptoms often contain intraepithelial cells with irregular nuclear contours (CINC). To investigate their nature and significance, we retrospectively studied biopsies and resection specimens from symptomatic patients that showed the following histologies: unremarkable mucosa (11 cases), active esophagitis (11 cases), infection (herpes: two cases; fungus: five cases), Barrett's esophagus (five cases), adenocarcinoma (three cases), and squamous cell carcinoma (two cases). H&E sections were reviewed to determine the number of intraepithelial CINC, neutrophils, eosinophils, and mononuclear cells with small, round nuclei typical of lymphocytes in five high-power fields. All specimens were also stained for S-100 protein, and six additional biopsies with numerous CINC were stained for leukocyte common antigen (LCA), L-26 (a B-cell marker), and Leu-22 and UCHL-1 (both T-cell markers). Clinical charts were reviewed to analyze endoscopic findings. The CINC had the immunohistochemical profile of T-lymphocytes: LCA (+), Leu-22 (+), UCHL-1 (+), L-26 (-), and S-100 protein (-). Their average number per high-power field was low in benign squamous epithelium away from tumors (average 0.8/high-power field) but much higher in biopsies with the other categories of histology, especially those with active esophagitis and infection (6.3/high-power field). The difference between the mean of the two tumor groups (0.8) and that of esophagitis (6.3) was statistically significant (p = 0.005). Of 11 patients with unremarkable biopsies, there was endoscopic evidence of esophagitis in five. The biopsies of these five showed an average number of CINC of 6.4, whereas the number was only 3.5 in the six with normal endoscopy (p = 0.15).(ABSTRACT TRUNCATED AT 250 WORDS)