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Evaluation of T-lymphocytes in esophageal mucosal biopsies
H H Wang1, M M Mangano, D A Antonioli
1Department of Pathology, Beth Israel Hospital, Boston, Massachusetts.
Insights
Intraepithelial T-lymphocytes, identified as cells with irregular nuclear contours (CINC) and mononuclear cells, may serve as an independent marker for esophagitis. Their numbers correlate with eosinophils, suggesting a role in esophageal inflammation.
Area of Science:
- Gastroenterology
- Immunology
- Pathology
Background:
- Intraepithelial cells with irregular nuclear contours (CINC) and mononuclear cells in esophageal biopsies were previously identified as T-lymphocytes.
- These cells were hypothesized to be an independent marker for esophagitis.
Purpose of the Study:
- To investigate the hypothesis that CINC and mononuclear cells are independent markers of esophagitis.
- To evaluate the correlation between T-lymphocyte counts and histologic findings of esophagitis.
Main Methods:
- Hematoxylin and eosin-stained biopsy specimens from 201 patients were analyzed.
- Counts of intraepithelial CINC and mononuclear cells were performed in high power fields.
- Immunohistochemistry (UCHL-1 for T-lymphocytes, L-26 for B-lymphocytes) was used on 22 biopsies.
- Clinical and endoscopic findings were reviewed and compared with histologic results.
Main Results:
- Immunohistochemistry confirmed >95% of CINC and mononuclear cells are T-lymphocytes.
- The sum of CINC and mononuclear cells accurately represents T-lymphocyte numbers.
- T-lymphocyte counts significantly correlated with eosinophil counts (R = 0.24, P = 0.0008).
- No significant correlation was found between T-lymphocytes and neutrophils (R = 0.069, P = 0.33).
- T-lymphocyte numbers were slightly higher in biopsies with esophagitis than without (12.7 vs 11.3, P = 0.23), but not significantly.
Conclusions:
- The study supports that intraepithelial CINC and mononuclear cells are indeed T-lymphocytes.
- These T-lymphocytes show a significant correlation with eosinophils, suggesting a role in esophageal inflammation.
- While not statistically significant in this study, the trend suggests T-lymphocytes may be a potential marker for esophagitis.
Abstract:
We previously demonstrated that in esophageal mucosal biopsies, intraepithelial cells with irregular nuclear contours (CINC) as well as mononuclear cells with round nuclei are T-lymphocytes and we suggested that they may be an independent marker of esophagitis. To investigate this hypothesis, we evaluated Hematoxylin and eosin-stained biopsy specimens from 201 consecutive patients (115 female, 86 male; mean age: 52 years) that showed either no accepted features of esophagitis (n = 122) or changes typical of esophageal reflux (n = 79). The number of intraepithelial CINC and mononuclear cells in the most densely populated high power field were counted. Twenty-two of these biopsies were also stained with UCHL-1 (T-lymphocyte marker) and L-26 (B-lymphocyte marker). All medical records were reviewed to determine clinical and endoscopic findings of esophagitis, which were then compared with the histologic results for correlations. The immunohistochemical results confirmed that the majority (> 95%) of CINC and mononuclear cells were T-lymphocytes, and the sum of CINC and mononuclear cells represents best the number of T-lymphocytes. The number of T-lymphocytes was significantly correlated with that of eosinophils (R = 0.24, P = 0.0008) but not with neutrophils (R = 0.069, P = 0.33). They were greater in number, although not significantly so, in the specimens with histologic evidence of esophagitis than those without (12.7 +/- 8.9 versus 11.3 +/- 7.7, P = 0.23).(ABSTRACT TRUNCATED AT 250 WORDS)