Dellon et al used immunostains for tryptase to identify mast cells in esophageal biopsies. Patients with eosinophilic esophagitis will have increased mast cells in the esophageal mucosa. The authors are from the University of North Carolina at Chapel Hill and North Carolina Central University.
Mast Cells Identified by Tryptase Staining
Grade
none
0
minimal staining, patchy and primarily in the basal epidermis
1
moderate staining but patchy
2
moderate to marked and more widespread
3
marked and diffuse
4
In eosinophilic esophagitis, mast cells may be either diffuse or patchy. With reflux esophagitis mast cells tend to be patchy, with a diffuse pattern uncommon.
The cutoff for mast cell density to identify eosinophilic esophagitis was >= 96 mast cells per square mm. The cutoff was 80% sensitive and 80% specific.
The presence of a positive result for mast cells and an eosinophilc count >= 50 per high power field was 91% sensitive and 95% specific.
The presence of a positive result for mast cells and an eosinophilc count >= 15 per high power field was 98% sensitive but 63% specific.
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