Original ArticlesNonadenomatous Dysplasia in Barrett Esophagus A Clinical, Pathologic, and DNA Content Flow Cytometric StudyRucker-Schmidt, Rachel L., MD*; Sanchez, Carissa A.†; Blount, Patricia L., MD† ‡; Ayub, Kumran, MD§ ∥ ¶; Li, Xiahong, PhD†; Rabinovitch, Peter S., MD, PhD♯; Reid, Brian J., MD, PhD† ‡ **; Odze, Robert D., MD, FRCPC*Author Information *Department of Pathology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA †Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center ‡Departments of Medicine ♯Pathology **Genome Sciences, University of Washington, Seattle, WA §Provena St Joseph Medical Center, Joliet ∥Adventist Bolingbrook Hospital, Bolingbrook ¶Advocate Christ Medical Center, Oak Lawn, IL Financial Support: NIH P01 CA91955 (C.A.S., P.L.B., K.A., X.L., R.D.O., P.S.R., B.J.R.). Correspondence: Robert D. Odze, MD, FRCPC, Department of Pathology, Harvard Medical School and Brigham and Women's Hospital, 75 Francis St. Boston, MA 02115 (e-mail: mailto:firstname.lastname@example.org). Presented in part at the annual United States and Canadian Academy of Pathology meeting in 2007. The American Journal of Surgical Pathology: June 2009 - Volume 33 - Issue 6 - p 886-893 doi: 10.1097/PAS.0b013e318198a1d4 Buy Metrics Abstract Rarely, dysplasia in Barrett's esophagus (BE) is composed of crypts lined by cuboidal-shaped cells that contain a centrally located nucleus, markedly increased nuclear/cytoplasmic ratio, but without nuclear stratification characteristic of conventional “adenomatous” dysplasia. The aim of this study was to evaluate the clinical and pathologic features, natural history, and DNA content flow cytometric abnormalities of BE patients with non-adenomatous dysplasia (NAD) in a cohort of BE patients enrolled in a prospective surveillance program. Eighteen patients with NAD identified over a 6 year period, in a cohort of 270 consecutive patients with BE and without esophageal adenocarcinoma (EA) at baseline, were evaluated for clinical and pathologic features, including association with conventional adenomatous dysplasia and EA, DNA content flow cytometric abnormalities (tetraploidy and aneuploidy) and outcome, over a mean follow-up period of 4.1 years. The findings in the 18 study patients were compared to those in the 252 remaining (control) patients without NAD. Control patients included 228 with metaplasia/indefinite for dysplasia, and 24 with conventional adenomatous dysplasia (13 low-grade, 11 high-grade). The prevalence rate of NAD in our BE cohort was 6.7% Of the 18 study patients, there were 17 were males and 1 female of mean age 66.7 years. The mean length of BE was 3.9 cm NAD foci were associated with goblet or non-goblet epithelium in 62% and 38% of cases, respectively. Ninety-four percent of patients with NAD (17/18) also had conventional adenomatous dysplasia (four with low-grade, 13 with high-grade) elsewhere in the esophagus at the same endoscopic procedure as the one that detected NAD. Patients with NAD had a significantly shorter length of BE compared to control patients with conventional adenomatous dysplasia (N=24) (p=0.03). Patients with NAD also showed a significantly higher rate of DNA content flow cytometric abnormalities compared to the entire cohort of control patients (38% vs. 11%, p=0.05). However, no significant differences regarding either flow cytometric abnormalities or progression to EA were found when the NAD patients were compared only to the 24 controls with conventional adenomatous dysplasia. NAD is a high grade histologic variant of intraepithelial neoplasia that is episodic in nature, and shows a high association with conventional adenomatous high-grade dysplasia. © 2009 Lippincott Williams & Wilkins, Inc.