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Int J Clin Exp Pathol 2(2),149-153; 2009

Original Article
Stem Cells might Participate in the Cell Turnover of Duodenal Adenomas

Carlos A Rubio

Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology, Karolinska Institute and University Hospital, 17176,
Stockholm, Sweden

Received 17 May 2008; Accepted in revision 30 June 2008; Available online 10 July 2008

Abstract: Eighty-three duodenal adenomas were stained with hematoxylin-eosin (H&E) and with anti-lysozyme
immunostain. Mature Paneth cells were those showing coarse brightly red cytoplasmic granules in H&E stain and
Paneth cell precursors were those lysozyme-expressing cells that had remained undetected in H&E stain. In the
adenomas, the number of mature Paneth cells/high power field varied from 4 to 12 (mean 6.5) in H&E stain, and
of lysozyme-expressing cells from 32 to 62 (mean 46.5) (p<0.05). Lysozyme-expressing cells were found
haphazardly distributed within the histological profile of the lesion, even in the most superficial cell layer of the
dysplastic glands. The latter suggests that if the innate programmed vector of cell migration were valid for
duodenal adenomas (from stem cells towards the bottom of the crypts for Paneth cells) the stem cells, normally
overlaying Paneth cells, would have been exfoliated into the lumen. Another, less likely option, is that mutated
stem cells at the bottom of duodenal adenomas translocate, in an unprecedented manner, the ontogenic signals
of migration for Paneth cells. This stochastic molecular option would imply a total reversal of the normal migratory
vector for Paneth cells, to a more aberrant, paradoxical migration flow, from stem cells to the villus domain,
before exfoliation. Because of the unique migratory direction of the Paneth cells in the crypts of Lieberkühn, the
duodenal adenoma emerges as a suitable histo-biological model to monitor the fate of stem cells. It is suggested
that stem cells, together with the other recordable mature cells, namely dysplastic enterocytes, Paneth cells and
goblet cells, participate in the cell turnover of duodenal adenomas. Further studies are necessary to definitively
validate the abovementioned suggested hypothesis. (IJCEP805004).

Key Words: Duodenum, adenomas, Paneth cells, stem cells, migration, turnover

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Address all correspondence to: Carlos A. Rubio, MD, PhD, Gastrointestinal and Liver, Pathology Research Laboratory, Department of
Pathology, Bldg P1/R8:02, Karolinska Institute and University Hospital, 17176, Stockholm, Sweden, Fax: 46 8 51774524; Email: