Fascin and ezrin expression in Barrett's esophagus progression to adenocarcinoma

BACKGROUND: Esophageal adenocarcinoma can arise in Barrett's esophagus (BE) by a sequential progression from specialized intestinal metaplasia (IM) to cancer through different grades of dysplasia. To date, the morphological identification of dysplasia represents the gold standard to stratify the risk of neoplastic progression of BE patients. However, it is not a sufficiently reliable predictor of cancer risk. For this purpose, the use of molecular biomarkers has been proposed, but none of these has yet been validated. Fascin and Ezrin, two cytoskeleton-associated proteins, have shown an altered expression in several types of human cancers but have never been assessed in the progression from BE to esophageal adenocarcinoma. AIM: To evaluate the Fascin and Ezrin expression in relation to the sequence of BE carcinogenesis. METHODS: Esophageal paraffin sections of 33 patients with BE, including 11 patients without dysplasia (IM), 11 patients with low-grade dysplasia (LGD) and 11 patients with high-grade dysplasia (HGD), were analyzed by immunohistochemistry to assess Fascin and Ezrin expression. RESULTS: Fascin was prevalently not expressed in IM sections (9%), and largely expressed in both LGD sections (54,5%) and HGD sections (63,6%). Fascin expression increased significantly during the sequence of BE carcinogenesis (p= 0,021). In IM sections, Ezrin expression was prevalently observed in cell apical membrane; in LGD sections, Ezrin was moderately present in cell cytoplasm; in HGD sections, Ezrin was intensely distributed in cell cytoplasm. Ezrin expression increased significantly during the sequence of BE carcinogenesis (p= 0,001). CONCLUSIONS: In the malignant transformation progress of BE, the increased expression of both Fascin and Ezrin correlates with such a malignant progression, and Ezrin also shows a tendency to translocate from cell membrane to cytoplasm.