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Archives of Pathology and Laboratory Medicine


Context: Histologically, the hallmark of active eosinophilic esophagitis (EoE) is the presence of intraepithelial eosinophils (iEos). Recently, studies have evaluated the etiologic role of intraepithelial mast cells (iMCs) in pathogenesis of EoE and residual disease. We aimed to evaluate diagnostic and prognostic value of iMCs in EoE by its prevalence in esophageal biopsy cases in association with presence of iEos and/or lymphocytes. Design: Esophageal biopsy cases were prospectively reviewed for presence of iEos, lymphocytes, and/or iMCs. An experienced gastroenterology pathologist at our institution quantitated the number of inflammatory cells. Immunohistochemistry (CD117) was used to highlight iMCs. Unpaired Student t test was used to analyze data with statistically significant P value of ,.05. Results: Thirty-one esophageal biopsy cases were examined. Eighteen (study group) cases had iEos and iMCs, with clinical diagnosis of EoE in 14 of these cases (Figure 14, A). The remaining 13 cases (control group) had intraepithelial lymphocytes (Figure 14, C) without any significant presence of iEos or iMCs, with clinical diagnosis of lymphocytic/reflux esophagitis. Unpaired Student t test showed statistically significant (P value ¼ .001) number of iMCs (mean iMCs, 40.1 6 6.1) in the study group compared to control group (mean iMCs, 3.1 6 1.4; Figure 14, B and D). Thus, increased iMCs were found to be associated with increased iEos during active EoE, and treated EoE with reduced iEos. In contrast, increased iMCs were not associated with other studied diseases. Conclusions: We conclude that iMCs can be used as a surrogate marker for diagnosis of EoE. Further studies are needed to determine prevalence of iMCs in residual disease, which can have clinical impact.





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