Difference between revisions of "Esophageal adenocarcinoma"

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| Caption    = Esophageal adenocarcinoma. [[H&E stain]].
| Caption    = Esophageal adenocarcinoma. [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      =
| Micro      = "invading" cell clusters or glands (gland cribriforming (more than rare) or desmoplasia or submucosa invasion); nuclear atypia of malignancy (variation of size, shape, staining), +/-mitoses
| Subtypes  =
| Subtypes  =
| LMDDx      = [[high-grade columnar dysplasia of the esophagus]], [[squamous cell carcinoma of the esophagus]],[[gastric adenocarcinoma]]
| LMDDx      = [[high-grade columnar dysplasia of the esophagus]], [[squamous cell carcinoma of the esophagus]],[[gastric adenocarcinoma]]
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| Grossing  =
| Grossing  =
| Site      =
| Site      =
| Assdx      =
| Assdx      = [[Barrett's esophagus]], [[high-grade columnar dysplasia of the esophagus]]
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx =  
| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  =
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| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
| Prognosis  =
| Prognosis  = often poor - as typically high stage at diagnosis
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    =
| Tx        =
| Tx        = EMR (early), surgery - esophagectomy
}}
}}
'''Esophageal adenocarcinoma''', also '''adenocarcinoma of the esophagus''', is a common malignant epithelial-derived tumour of the distal esophagus, that classically arises in the context of [[Barrett's esophagus]].
'''Esophageal adenocarcinoma''', also '''adenocarcinoma of the esophagus''', is a common malignant epithelial-derived tumour of the distal esophagus, that classically arises in the context of [[Barrett's esophagus]].
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*May be difficult to distinguish from adenocarcinoma of the stomach.
*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>
**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>
Symptoms:
*[[Dysphagia]].
Associations:
*[[Barrett's esophagus]].
**[[Gastroesophageal reflux disease]].
*Hiatal hernia.<ref name=pmid24495377>{{cite journal |author=Jiang X, Tseng CC, Bernstein L, Wu AH |title=Family history of cancer and gastroesophageal disorders and risk of esophageal and gastric adenocarcinomas: a case-control study |journal=BMC Cancer |volume=14 |issue= |pages=60 |year=2014 |pmid=24495377 |pmc=3915076 |doi=10.1186/1471-2407-14-60 |url=}}</ref>
*Family history - [[prostate cancer]].<ref name=pmid24495377/>


===Treatment===
===Treatment===

Revision as of 02:11, 18 June 2014

Esophageal adenocarcinoma
Diagnosis in short

Esophageal adenocarcinoma. H&E stain.
LM "invading" cell clusters or glands (gland cribriforming (more than rare) or desmoplasia or submucosa invasion); nuclear atypia of malignancy (variation of size, shape, staining), +/-mitoses
LM DDx high-grade columnar dysplasia of the esophagus, squamous cell carcinoma of the esophagus,gastric adenocarcinoma
Stains CK7 +ve, CK20 +ve, p63 -ve
Associated Dx Barrett's esophagus, high-grade columnar dysplasia of the esophagus
Prognosis often poor - as typically high stage at diagnosis
Treatment EMR (early), surgery - esophagectomy

Esophageal adenocarcinoma, also adenocarcinoma of the esophagus, is a common malignant epithelial-derived tumour of the distal esophagus, that classically arises 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.[1]

Symptoms:

Associations:

Treatment

  • Adenocarcinoma in situ (AIS) - may be treated with endoscopic mucosal resection & follow-up.[3]
  • Surgery - esophagectomy.

Esophagus versus stomach

The convention is it's esophageal if both of the following are true:[4]

  1. Epicenter of tumour is in the esophagus.
  2. Barrett's mucosa is present.

Microscopic

Features:

  • Adenocarcinoma:
    • "Invading" cell clusters or glands.
      • Cribriforming (more than rare) or desmoplasia or "deep" invasion (into submucosa).
    • Nuclear atypia of malignancy:
      • Size variation.
      • Shape variation.
      • Staining variation.
    • +/-Mitoses (common).

DDx:

Images

  • Esophageal adenocarcinoma - very low mag. (WC)

  • Esophageal adenocarcinoma - low mag. (WC)

  • Esophageal adenocarcinoma - intermed. mag. (WC)

  • Esophageal adenocarcinoma - high mag. (WC)

Grading

Graded like other adenocarcinoma:[4]

  • >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:[5][6]

  • 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

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. 
Malignant-appearing glands are 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.

See also

References

  1. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Esophagus_11protocol.pdf. Accessed on: 6 April 2012.
  2. ↑ 2.0 2.1 Jiang X, Tseng CC, Bernstein L, Wu AH (2014). "Family history of cancer and gastroesophageal disorders and risk of esophageal and gastric adenocarcinomas: a case-control study". BMC Cancer 14: 60. doi:10.1186/1471-2407-14-60. PMC 3915076. PMID 24495377. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3915076/.
  3. ↑ Sampliner, RE. (Jul 2009). "Endoscopic therapy for Barrett's esophagus.". Clin Gastroenterol Hepatol 7 (7): 716-20. doi:10.1016/j.cgh.2009.03.011. PMID 19306943.
  4. ↑ 4.0 4.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 168. ISBN 978-0781765275.
  5. ↑ Pech, O.; May, A.; Rabenstein, T.; Ell, C. (Nov 2007). "Endoscopic resection of early oesophageal cancer.". Gut 56 (11): 1625-34. doi:10.1136/gut.2006.112110. PMC 2095648. PMID 17938435. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095648/.
  6. ↑ Thosani, N.; Singh, H.; Kapadia, A.; Ochi, N.; Lee, JH.; Ajani, J.; Swisher, SG.; Hofstetter, WL. et al. (Nov 2011). "Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis.". Gastrointest Endosc. doi:10.1016/j.gie.2011.09.016. PMID 22115605.
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