Persistent Dysplasia within Long-Segment Barrett’s Esophagus in a Patient with Gardner’s Syndrome

We read with great interest the case reported as an “Images in Focus” paper by Dr Wolfsen [1]. In 1995 we made a similar diagnosis in a 32-year-old woman with known Gardner’s syndrome and persistent low-grade dysplasia (intraepithelial neoplasia) within long-segment Barrett’s esophagus. The patient refused any further treatment despite follow-up with biopsy. Since 1995, the lesion has been documented 16 times by endoscopic follow-up with biopsy.

For years we have been searching for suitable markers to support our hypothesis of the existence of a lesion related to Gardner’s syndrome rather than to Barrett’s esophagus. We failed to find such supporting evidence despite the finding of the so-called “top-down” morphology of the neoplasia, which is similar to that of colonic adenomas, in contrast to the ”down-top” morphology that typifies Barrett’s-associated neoplasia.

Figure 1 Barrett’s epithelium with low-grade dysplasia (intraepithelial neoplasia), showing the so-called “top-down” morphology: the neoplastic glands are confined to the upper part of the biopsy field and the well-preserved parts of the glands are located in the lower section of the mucosa.

Reference

• 1 Wolfsen H C. Polypoid Barrett’s high-grade dysplasia in a patient with familial adenomatous polyposis: a unique association.  Endoscopy. 2005;  37 280