Mucosal cysts in Barrett's mucosa with dysplasia

The frequency of glandular cysts occurring in the Barrett's mucosa was investigated in areas adjacent to invasive adenocarcinoma in 32 resected esophagi. Cysts in the metaplastic glands of the Barrett mucosa were present in areas with and without dysplasia in 31 of the 32 specimens. The mean cyst index (i.e. the number of glandular cysts divided by the length-in mm-of mucosa analyzed) was 2.3 in the non-dysplastic Barrett mucosa, and 2.5 in the Barrett mucosa with dysplasia. Significantly lower indices (p less than 0.001) were found in areas with metaplastic glands covered by "healing" squamous epithelium (0.47) and in the gastric mucosa of the same patients (0.15) as well as in 10 control esophagi underneath normal squamous epithelium (0.11). The outlet of the dilated glands was often obstructed by clusters of dysplastic cells or papillary formations with atypical cells, substantiating on obstructive-causal mechanism in these cysts. Other cysts were partially or totally replaced by dysplastic epithelium. The present findings may be of importance for the histological differential diagnosis between dysplasia and highly differentiated adenocarcinomas in biopsy specimens from the Barrett Mucosa.