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2 - Pathology of Esophageal Cancer

Published online by Cambridge University Press:  08 August 2009

By
Harriet M. R. Deere
Edited by
Sheila C. Rankin
Harriet M. R. Deere
Affiliation:
Consultant Histopathologist, Department of Histopathology, Guy's & St Thomas' Foundation Trust, London, UK
Sheila C. Rankin
Affiliation:
Guy's and St Thomas' Hospital
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Summary

Introduction

Worldwide, squamous cell carcinoma is the most common malignant epithelial tumor of the esophagus. The majority of remaining tumors are adenocarcinomas, the incidence of which has been increasing dramatically in the last few decades in the Western world. Rarely, adenosquamous carcinoma and small cell carcinoma may occur.

This chapter will focus on the morphologic features of esophageal carcinoma and associated precursor lesions.

Histopathology of tumor types

Squamous cell carcinoma

Precursor lesions – hyperplasia and dysplasia

Squamous cell carcinoma is thought to develop through a multistep process from basal hyperplasia due to chronic esophagitis through increasing severity of dysplasia to invasion.

Dysplasia is defined as the presence of unequivocal neoplastic cells confined to the epithelium. It is seen more commonly in high cancer risk areas, e.g., China, is frequently seen adjacent to invasive carcinomas, and is often multifocal.

Traditionally, dysplasia has been classified as mild, moderate, or severe (and carcinoma in situ). More recently, a two-grade system for dysplasia in the gastrointestinal tract is preferred, with mild and moderate atypia being classed as low grade and severe dysplasia and carcinoma in situ as high grade.

The risk of carcinoma rises with increasing severity of dysplasia. A recent study from China has shown a relative risk of 2.9 for mild dysplasia, 9.8 for moderate, 28.3 for severe, and 34.4 for carcinoma in situ at 13 years follow-up.

Type
Chapter
Information
Carcinoma of the Esophagus , pp. 14 - 27
Publisher: Cambridge University Press
Print publication year: 2007

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References

Dawsey, S. M., Lewin, K. J., Wang, G. Q., et al. Squamous esophageal histology and subsequent risk of squamous cell carcinoma of the esophagus. A prospective follow-up study from Linxian, China. Cancer, 74 (1994), 1686–92.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Qui, S. L. and Yang, G. R.. Precursor lesions of esophageal cancer in high-risk populations in Henan Province, China. Cancer, 62 (1998), 551–7.Google Scholar
Morita, M., Kuwano, H., Yasuda, M., et al. The multicentric occurrence of squamous epithelial dysplasia and squamous cell carcinoma in the oesophagus. Cancer, 74 (1994), 2889–95.3.0.CO;2-K>CrossRefGoogle Scholar
Wang, G. Q., Abnet, C. C., Shen, Q., et al. Histological precursors of oesophageal squamous cell carcinoma: results from a 13 year prospective follow up study in a high risk population. Gut 54 (2005), 187–92.CrossRefGoogle Scholar
Dawsey, S. M., Wang, G. Q., Weinstein, W. M., et al. Squamous dysplasia and early esophageal cancer in the Linxian region of China: Distinctive endoscopic lesions. Gastroenterology, 105 (1993), 1333–40.CrossRefGoogle ScholarPubMed
Lewin, K. J. and Appelman, H. D.. Atlas of Tumor Pathology, 3rd Series, Fascicle 18. Tumors of the Esophagus and Stomach. (Washington DC: Armed Forces Institute of Pathology, 1996).Google Scholar
Froelicher, P. and Miller, G.. The European experience with esophageal cancer limited to the mucosa and submucosa. Gastrointest Endosc, 32 (1986), 88–90.CrossRefGoogle ScholarPubMed
Bogomoletz, W. V., Molas, G., Gayet, B., and Potet, F.. Superficial squamous cell carcinoma of the esophagus. A report of 76 cases and review of the literature. Am J Surg Pathol, 13 (1989), 535–46.CrossRefGoogle ScholarPubMed
Kato, H., Tachimori, Y., Watanabe, H., et al. Intramural metastasis of thoracic esophageal carcinoma. Int J Cancer, 50 (1992), 49–52.CrossRefGoogle ScholarPubMed
Kuwano, H.. Peculiar histopathologic features of esophageal cancer. Surg Today, 28 (1998), 573–5.CrossRefGoogle ScholarPubMed
Kuwano, H., Ohno, S., Matsuda, H., et al. Serial histologic evaluation of multiple primary squamous cell carcinomas of the esophagus. Cancer, 61 (1988), 1635–8.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Pesko, P., Rakic, S., Milicevic, M., et al. Prevalence and clinicopathologic features of multiple squamous cell carcinoma of the esophagus. Cancer, 73 (1994), 2687–90.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Kuwano, H., Ueo, H., Sugimachi, K., et al. Glandular or mucus-secreting components in squamous cell carcinoma of the esophagus. Cancer, 56 (1985), 514–18.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Takubo, K., Sasajima, K., Yamashita, K., et al. Morphological heterogeneity of esophageal carcinoma. Acta Pathol Jpn, 39 (1989), 180–9.Google ScholarPubMed
Fujiwara, Y., Nakagawa, K., Tanaka, T., et al. Small cell carcinoma of the esophagus combined with superficial esophageal cancer. Hepatogastroenterology, 43 (1996), 1360–9.Google ScholarPubMed
Sarbia, M., Vereet, P., Bittinger, F., et al. Basaloid squamous carcinoma of the esophagus. Diagnosis and prognosis. Cancer, 79 (1997), 1871–8.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Boulay, C. Du and Isaacson, P.. Carcinoma of the oesophagus with spindle cell features. Histopathology, 5 (1981), 403–14.CrossRefGoogle ScholarPubMed
Biemond, P., Kate, F. J. ten, and Blankenstein, M.. Esophageal verrucous carcinoma: histologically a low-grade malignancy but a fatal disease. J Clin Gastroenterol, 13 (1991), 102–7.CrossRefGoogle ScholarPubMed
Christensen, W. N. and Sternberg, S. S.. Adenocarcinoma of the upper esophagus arising in ectopic gastric mucosa; two case reports and review of the literature. Am J Surg Pathol, 11 (1987), 397–402.CrossRefGoogle ScholarPubMed
Lauwers, G. Y., Scott, G. V., and Vauthey, G. N.. Adenocarcinoma of the upper esophagus arising in cervical ectopic gastric mucosa: Rare evidence of malignant potential of so-called “inlet patch.”Dig Dis Sci, 43 (1998), 901–7.CrossRefGoogle ScholarPubMed
Endoh, Y., Miyawaki, M., Tamura, G., et al. Esophageal adenocarcinoma that probably originated in the esophageal gland duct: A case report. Pathol Int, 49 (1999), 156–9.CrossRefGoogle ScholarPubMed
Sampliner, R. E.. Practice guidelines on the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol, 93 (1998), 1028–31.CrossRefGoogle ScholarPubMed
Watson, A., Heading, R. C., and Shepherd, N. A.. Guidelines for Diagnosis and Management of Barrett's Columnar-Lined Oesophagus. A Report of the Working Party of the British Society of Gastroenterology. (2005).Google Scholar
N. A. Shepherd and L. R. Biddlestone. The histopathology and cytopathology of Barrett's oesophagus. In CPD Bulletin Cellular Pathology, ed. Manek, S.. (London: Rila Publications, 1999), 1, 39–44.Google Scholar
Takubo, K., Nixon, J. M., and Jass, J. R.. Ducts of esophageal glands proper and Paneth cells in Barrett's esophagus: frequency in biopsy specimens. Pathology, 27 (1995), 315–17.CrossRefGoogle ScholarPubMed
Mohammed, I. A., Streutker, C. J., and Riddell, R. H.. Utilization of cytokeratins 7 and 20 does not differentiate between Barrett's esophagus and gastric cardiac intestinal metaplasia. Mod Pathol, 15 (2002), 611–16.CrossRefGoogle Scholar
Odze, R. D.. Cytokeratin 7/20 immunostaining: Barrett's oesophagus or gastric intestinal metaplasia. Lancet, 359 (2000), 1711–13.CrossRefGoogle Scholar
Ormsby, A. H., Goldblum, J. R., and Rice, T. W., et al. Cytokeratin subsets can reliably distinguish Barrett's oesophagus from intestinal metaplasia of the stomach. Hum Pathol, 30 (1999), 288–94.CrossRefGoogle ScholarPubMed
Gillen, P., Keeling, P., Byrne, P. J., et al. Experimental columnar metaplasia in the canine oesophagus. Br J Surg, 75 (1988), 113–15.CrossRefGoogle ScholarPubMed
Wright, N. A.. Migration of the ductular elements of gut-associated glands gives clues to the histogenesis of structures associated with responses to acid hypersecretory state: the origins of “gastric metaplasia” in the duodenum, of the specialized mucosa of Barrett's esophagus and of pseudopyloric metaplasia. Yale J Biol Med, 69 (1996), 147–53.Google ScholarPubMed
Glickman, J. N., Chen, Y. Y., Wang, H. H., et al. Phenotypic characteristics of a distinctive multilayered epithelium suggests that it is a precursor in the development of Barrett's esophagus. Am J Surg Pathol, 25 (2001), 569–78.CrossRefGoogle ScholarPubMed
Altorki, N. K., Sunagawa, M., Little, A. G., Skinner, D. B.. High-grade dysplasia in the columnar lined esophagus. Am J Surg, 161 (1991), 97–9.CrossRefGoogle ScholarPubMed
Pera, M., Trastek, V. F., Carpenter, H. A., et al. Barrett's esophagus with high-grade dysplasia: an indication for esophagectomy?Ann Thorac Surg, 54 (1992), 199–204.CrossRefGoogle ScholarPubMed
Tseng, E. E., Wu, T. T., Yeo, C. J., and Heitmiller, R. F.. Barrett's esophagus with high grade dysplasia: surgical results and long-term outcome – an update. J Gastrointest Surg, 7 (2003), 164–70.CrossRefGoogle ScholarPubMed
Miros, M., Kerlin, P., and Walker, N.. Only patients with dysplasia progress to adenocarcinoma in Barrett's oesophagus. Gut, 32 (1991), 1441–6.CrossRefGoogle ScholarPubMed
Sharma, P., Morales, T. G., Bhattacharyya, A., et al. Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and gastric cardia. Gut, 46 (1999), 9–13.CrossRefGoogle Scholar
Levine, D. S.. Management of dysplasia in the columnar-lined esophagus. Gastroenterol Clin North Am, 26 (1997), 613–34.CrossRefGoogle ScholarPubMed
Gurski, R. R., Peters, J. H., Hagen, J. A., et al. Barrett's esophagus can and does regress after anti-reflux surgery: a study of prevalence and predictive features. J Am Coll Surg, 197 (2003), 882–3.Google Scholar
Cooper, B. T., Chapman, W., Neumann, C. S., and Gearty, J. C.. Continuous treatment of Barrett's oesophagus patients with proton pump inhibitors up to 13 years: observations on regression and cancer incidence. Aliment Pharmacol Ther, 15 (2006), 727–33.CrossRefGoogle Scholar
Biddlestone, L. R., Barham, C. P., Wilkinson, S. P., et al. The histopathology of treated Barrett's esophagus. Squamous re-epithelialization after acid suppression and laser and photo-dynamic therapy. Am J Surg Pathol, 22 (1998), 239–45.CrossRefGoogle Scholar
Paraf, F., Flejou, J. F., Pignon, J. P., et al. Surgical pathology of adenocarcinoma arising in Barrett's esophagus. Analysis of 67 cases. Am J Surg Pathol, 19 (1995), 183–91.CrossRefGoogle ScholarPubMed
Chejfec, G., Jablokow, V. R., and Gould, V. E.. Linitis plastica carcinoma of the oesophagus. Cancer, 51 (1983), 2139–43.3.0.CO;2-Y>CrossRefGoogle Scholar
Sarbia, M.. The histological appearances of oesophageal adenocarcinoma – an analysis based on 215 resection specimens. Virchows Arch, 44 (2006), 532–8.CrossRefGoogle Scholar
McKechnie, J. C. and Fechner, R. E.. Choriocarcinoma and adenocarcinoma of the esophagus with gonadotrophin secretion. Cancer, 27 (1971), 694–702.3.0.CO;2-H>CrossRefGoogle Scholar
Wasan, S. H., Schofiled, J. B., Krausz, T., et al. Combined choriocarcinoma and yolk sac tumour arising in Barrett's esophagus. Cancer, 73 (1994), 514–17.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
Casas, F., Ferrer, F., Farrus, B., et al. Primary small cell carcinoma of the esophagus: A review of the literature with emphasis on therapy and prognosis. Cancer, 80 (1997), 1366–72.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Greene, F. L., Page, D. L., Fleming, I. D., et al., eds. AJCC Cancer Staging Manual, 6th edn. (New York: Springer, 2002).CrossRefGoogle Scholar
Siewert, J. R. and Stein, H. J.. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 85 (1998), 1457–9.Google ScholarPubMed
Ibrahim, N. B. N.. ACP Best Practice No.155. Guidelines for handling oesophageal biopsies and resection specimens and their reporting. J Clin Pathol, 53 (2000), 89–94.CrossRefGoogle ScholarPubMed
Mapstone, N.. Minimum Dataset for Oesophageal Carcinoma Histopathology Reports. (London: The Royal College of Pathologists, 2006).Google Scholar
Ide, H., Nakamura, T., Hayashi, K., et al. Esophageal squamous cell carcinoma: pathology and prognosis. World J Surg, 18 (1994), 321–30.CrossRefGoogle ScholarPubMed
Robey-Cafferty, S. S., el-Naggar, A. K., Sahin, A. A., et al. Prognostic factors in esophageal squamous carcinoma – a study of histologic features, blood-group expression, and DNA ploidy. Am J Clin Pathol, 95 (1991), 844–9.CrossRefGoogle ScholarPubMed
Gu, Y., Swisher, S. G., Ajani, J. A., et al. The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer, 106 (2006), 1017–25.CrossRefGoogle ScholarPubMed
Kawahara, K., Maekawa, K., Okabayashi, K., et al. The number of lymph node metastases influences survival in esophageal cancer. J Surg Oncol, 67 (1998), 160–3.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
Dexter, S. P., Sue-Ling, H., McMahon, M. J., et al. Circumferential resection margin involvement: an independent predictor of survival following surgery for oesophageal cancer. Gut, 48 (2001), 667–70.CrossRefGoogle ScholarPubMed
Sagar, P. M., Johnston, D., McMahon, M. J., et al. Significance of circumferential resection margin involvement after oesophagectomy for cancer. Br J Surg, 80 (1993), 1386–8.CrossRefGoogle ScholarPubMed
Theunissen, P., Borchard, F., and Poortvliet, D. C. J.. Histopathological evaluation of oesophageal carcinoma. The significance of venous invasion. Br J Surg, 78 (1991), 930–2.CrossRefGoogle ScholarPubMed
Holscher, A. H., Bollschweiler, E., Schneider, P. M., and Siewert, J. R.. Prognosis of early esophageal cancer. Comparison between adeno-carcinoma and squamous-cell carcinoma. Cancer, 76 (1995), 178–86.3.0.CO;2-D>CrossRefGoogle Scholar
Mariette, C., Finzi, L., Piessen, G., et al. Esophageal carcinoma: prognostic differences between squamous cell carcinoma and adenocarcinoma. World J Surg, 29 (2005), 39–45.CrossRefGoogle ScholarPubMed
Kanamoto, A., Kato, H., Tachimori, Y., et al. No prognostic significance of p53 expression in esophageal squamous cell carcinoma. J Surg Oncol, 72 (1999), 94–8.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Wang, K. C.Chow, K. H. Chi, et al. Prognosis of esophageal squamous cell carcinoma: Analysis of clinicopathological and biological factors. Am J Gastroenterol, 94 (1999), 1933–40.CrossRefGoogle ScholarPubMed
Darnton, S. J., Allen, S. M., Edwards, C. W., and Matthews, H. R.. Histopathological findings in oesophageal carcinoma with and without preoperative chemotherapy. J Clin Pathol, 46 (1993), 51–5.CrossRefGoogle ScholarPubMed
Mandard, A. M., Dalibard, F., Mandard, J. C., et al. Pathologic assessment of tumour regression after preoperative chemo-radiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer, 73 (1994), 2680–6.3.0.CO;2-C>CrossRefGoogle Scholar

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