Introduction: The number of Foxp3+ lymphocytes is increased in patients with esophageal carcinoma. Little is known about Foxp3+ cells count in Barret's esophagus, which is a precancerous state for esophageal cancer. A i m: To count the number of Foxp3+ lymphocytes in tissue samples from patients with Barrett's and compare it with samples from individuals with esophagitis and esophageal cancer.
Materials and methods: 43 patients were enrolled to the study: 14 with esophageal carcinoma, 15 with Barrett's esophagus and 14 with non-metaplastic esophagitis. Every patient undergone gastroscopy during which a tissue sample was taken. Foxp3+ lymphocytes and CD4+ lymphocytes were detected by using immunohistochemistry.
Results: Mean density of Foxp3+ cells in patients with esophagitis was 7.37/10HPF (range: 1-9), 18.5/10HPF (range: 5-29) and 26.8/10HPF (range: 16-40) in patients with dysplastic and non-dysplastic BE, respectively and 47.92/10HPF in individuals with esophageal a carcinoma. These intergroup differences turned out to be statistically significant (p = 0.000; Fig. 3). Patients, either with dysplasia or without, presented with significantly higher Foxp3+ cell counts than the subjects with esophagitis (p = 0.0003 and p = 0.0006, respectively). Also the number of Foxp3+ lymphocytes in esophageal adenocarcinoma specimens turned out to be significantly higher than in esophagitis (p = 0.0001), non-dysplastic and dysplastic BE tissue (p = 0.016 and p = 0.00047, respectively).
Conclusions: Barrett's metaplasia, either with dysplasia or without, is associated with an evident increase in the number of Foxp3 lymphocytes within the esophagogastric junction mucosa. Restoration of lymphocyte balance in esophageal tissue might prevent malignant transformation of Barrett's metaplasia.
Keywords: Immunohistochemistry; Barrett’s esophagus; Esophageal cancer; Regulatory T-cells.