Difference between revisions of "Esophageal adenocarcinoma"

Line 1:

~~#redirect~~ [[~~Esophagus#Esophageal_adenocarcinoma~~]]

'''Esophageal adenocarcinoma''', also '''adenocarcinoma of the esophagus''', is a common malignant epithelial-derived tumour of the distal esophagus, that classically arising in the context of [[Barrett's esophagus]].

==General==

*Often a prognosis poor - as diagnosed in a late stage.

*May be difficult to distinguish from adenocarcinoma of the stomach.

**By convention (in the ''[[CAP checklist]]'') gastroesophageal junction carcinomas are staged as esophageal carcinomas.<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Esophagus_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Esophagus_11protocol.pdf]. Accessed on: 6 April 2012.</ref>

===Tx===

*Adenocarcinoma in situ (AIS) - may be treated with endoscopic mucosal resection & follow-up.<ref name=pmid19306943/>

*Surgery - esophagectomy.

===Esophagus versus stomach===

The convention is it's esophageal if both of the following are true:<ref name=Ref_WMSP168>{{Ref WMSP|168}}</ref>

#Epicenter of tumour is in the esophagus.

#Barrett's mucosa is present.

==Microscopic==

Features:

*Adenocarcinoma:

**Cell clusters that form glands.

**Nuclear atypia of malignancy:

***Size variation.

***Shape variation.

***Staining variation.

**Mitoses common.

====Images====

Image:Esophageal_adenocarcinoma_-_very_low_mag.jpg |Esophageal adenocarcinoma - very low mag. (WC)

Image:Esophageal_adenocarcinoma_-_intermed_mag.jpg |Esophageal adenocarcinoma - intermed. mag. (WC)

</gallery>

====Grading====

Graded like other adenocarcinoma:<ref name=Ref_WMSP168>{{Ref WMSP|168}}</ref>

*>95 % of tumour in glandular arrangement = ''well-differentiated''.

*95-50% of tumour in glandular arrangement= ''moderately-differentiated''.

*<50% of tumour in glandular arrangment = ''poorly-differentiated''.

====Staging====

Early esophageal adenocarcinoma has its own staging system:<ref>{{Cite journal | last1 = Pech | first1 = O. | last2 = May | first2 = A. | last3 = Rabenstein | first3 = T. | last4 = Ell | first4 = C. | title = Endoscopic resection of early oesophageal cancer. | journal = Gut | volume = 56 | issue = 11 | pages = 1625-34 | month = Nov | year = 2007 | doi = 10.1136/gut.2006.112110 | PMID = 17938435 | PMC = 2095648 }}</ref><ref>{{Cite journal | last1 = Thosani | first1 = N. | last2 = Singh | first2 = H. | last3 = Kapadia | first3 = A. | last4 = Ochi | first4 = N. | last5 = Lee | first5 = JH. | last6 = Ajani | first6 = J. | last7 = Swisher | first7 = SG. | last8 = Hofstetter | first8 = WL. | last9 = Guha | first9 = S. | title = Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. | journal = Gastrointest Endosc | volume = | issue = | pages = | month = Nov | year = 2011 | doi = 10.1016/j.gie.2011.09.016 | PMID = 22115605 | URL = http://www.sciencedirect.com/science/article/pii/S0016510711022048 }}</ref>

*M1 = lamina propria.

*M2 = superficial muscularis mucosae.

*M3 = submucosa.

*M4 = muscularis propria.

==IHC==

*CK7 +ve.

*CK20 +ve.

To rule-out SCC:

*p63 -ve.

*HWMK -ve.

==Sign out==

<pre>

GASTROESOPHAGEAL JUNCTION, RESECTION:

- INTRAMUCOSAL ADENOCARCINOMA, pT1a, pNx, SEE TUMOUR SUMMARY.

-- MUCOSAL MARGIN HAS CAUTERIZED DYSPLASTIC EPITHELIUM, SEE COMMENT.

-- DEEP MARGIN NEGATIVE FOR MALIGNANCY.

COMMENT:

The cauterized dysplastic epithelium cannot be further interpreted. Definite tumour is

within 1 mm of the cauterized epithelium. Close follow-up and re-biopsy (or

endoscopic re-resection if clinically indicated) is recommended.

This case was partially reviewed internally. There is agreement on the presence of

intramucosal adenocarcinoma and dysplastic epithelium at the mucosal margin.

</pre>

==See also==

*[[Esophagus]].

==References==

[[Category:Diagnosis]]

[[Category:Esophagus]]

Difference between revisions of "Esophageal adenocarcinoma"

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@@ Line 1: / Line 1: @@
-#redirect [[Esophagus#Esophageal_adenocarcinoma]]
+'''Esophageal adenocarcinoma''', also '''adenocarcinoma of the esophagus''', is a common malignant epithelial-derived tumour of the distal esophagus, that classically arising in the context of [[Barrett's esophagus]].
+==General==
+*Often a prognosis poor - as diagnosed in a late stage.
+*May be difficult to distinguish from adenocarcinoma of the stomach.
+**By convention (in the ''[[CAP checklist]]'') gastroesophageal junction carcinomas are staged as esophageal carcinomas.<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Esophagus_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Esophagus_11protocol.pdf]. Accessed on: 6 April 2012.</ref>
+===Tx===
+*Adenocarcinoma in situ (AIS) - may be treated with endoscopic mucosal resection & follow-up.<ref name=pmid19306943/>
+*Surgery - esophagectomy.
+===Esophagus versus stomach===
+The convention is it's esophageal if both of the following are true:<ref name=Ref_WMSP168>{{Ref WMSP|168}}</ref>
+#Epicenter of tumour is in the esophagus.
+#Barrett's mucosa is present.
+==Microscopic==
+Features:
+*Adenocarcinoma:
+**Cell clusters that form glands.
+**Nuclear atypia of malignancy:
+***Size variation.
+***Shape variation.
+***Staining variation.
+**Mitoses common.
+====Images====
+<gallery>
+Image:Esophageal_adenocarcinoma_-_very_low_mag.jpg |Esophageal adenocarcinoma - very low mag. (WC)
+Image:Esophageal_adenocarcinoma_-_intermed_mag.jpg |Esophageal adenocarcinoma - intermed. mag. (WC)
+</gallery>
+====Grading====
+Graded like other adenocarcinoma:<ref name=Ref_WMSP168>{{Ref WMSP|168}}</ref>
+*>95 % of tumour in glandular arrangement = ''well-differentiated''.
+*95-50% of tumour in glandular arrangement= ''moderately-differentiated''.
+*<50% of tumour in glandular arrangment = ''poorly-differentiated''.
+====Staging====
+Early esophageal adenocarcinoma has its own staging system:<ref>{{Cite journal  | last1 = Pech | first1 = O. | last2 = May | first2 = A. | last3 = Rabenstein | first3 = T. | last4 = Ell | first4 = C. | title = Endoscopic resection of early oesophageal cancer. | journal = Gut | volume = 56 | issue = 11 | pages = 1625-34 | month = Nov | year = 2007 | doi = 10.1136/gut.2006.112110 | PMID = 17938435 | PMC = 2095648 }}</ref><ref>{{Cite journal  | last1 = Thosani | first1 = N. | last2 = Singh | first2 = H. | last3 = Kapadia | first3 = A. | last4 = Ochi | first4 = N. | last5 = Lee | first5 = JH. | last6 = Ajani | first6 = J. | last7 = Swisher | first7 = SG. | last8 = Hofstetter | first8 = WL. | last9 = Guha | first9 = S. | title = Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. | journal = Gastrointest Endosc | volume =  | issue =  | pages =  | month = Nov | year = 2011 | doi = 10.1016/j.gie.2011.09.016 | PMID = 22115605 | URL = http://www.sciencedirect.com/science/article/pii/S0016510711022048 }}</ref>
+*M1 = lamina propria.
+*M2 = superficial muscularis mucosae.
+*M3 = submucosa.
+*M4 = muscularis propria.
+==IHC==
+*CK7 +ve.
+*CK20 +ve.
+To rule-out SCC:
+*p63 -ve.
+*HWMK -ve.
+==Sign out==
+<pre>
+GASTROESOPHAGEAL JUNCTION, RESECTION:
+- INTRAMUCOSAL ADENOCARCINOMA, pT1a, pNx, SEE TUMOUR SUMMARY.
+-- MUCOSAL MARGIN HAS CAUTERIZED DYSPLASTIC EPITHELIUM, SEE COMMENT.
+-- DEEP MARGIN NEGATIVE FOR MALIGNANCY.
+COMMENT:
+The cauterized dysplastic epithelium cannot be further interpreted. Definite tumour is
+within 1 mm of the cauterized epithelium. Close follow-up and re-biopsy (or
+endoscopic re-resection if clinically indicated) is recommended.
+This case was partially reviewed internally. There is agreement on the presence of
+intramucosal adenocarcinoma and dysplastic epithelium at the mucosal margin.
+</pre>
+==See also==
+*[[Esophagus]].
+==References==
+{{Reflist|2}}
 [[Category:Diagnosis]]
+[[Category:Esophagus]]