A CASE OF BARRETT ULCER : LIGHT AND ELECTRON MICROSCOPIC OBSERVATION

A 71-year-old man with esophagus lined by columnar epithelium who complained heart burn was reported. Roentgenographic study showed an esophageal ulcer accompanied by sliding hiatal hernia. Endoscopy revealed an ulcer and stenosis at the level of 37cm from incisor.In this study, esophageal biopsies were obtained from the ulcer edge, and those were studied by light and electron microscopy. Squamous epithelium and columnar epithelium were often seen in the same specimen by light microscope. The columnar epithelium with a villiform surface was composed of abundant tall columnar cells and scattered goblet cells. These tall columnar cells were called principal cells. This type of columnar epithelium was compatible with specialized columnar epithelium of Barrett esophagus.The columnar epithelium contained three cell types by electron microscopic observation. These were principal cell, goblet cell and enterochromaffin cell. The principal cells contained many granules up to 1.2μm in diameter, and had well developed microvilli on the apical surface. Spherical bodies, approximately 35 to 50nm in diameter, were found interspersed between the microvilli. The cytoplasm of the goblet cell was packed with well formed mucous granules and resembled those described in the small intestine. The fine structure of enterochromaffin cells closely resembled that of enterochromaffin cells found in other portions of the alimentary tract.We conclude that the epithelium of Barrett esophagus can be distinguished morphologically from other alimentary epithelia in this way.