Esophageal adenocarcinoma

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.

Treatment

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

Esophagus versus stomach

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

1. Epicenter of tumour is in the esophagus.
2. 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.

DDx:

• High-grade columnar dysplasia of the esophagus.
• Squamous cell carcinoma of the esophagus.

Images

• 

  Esophageal adenocarcinoma - very low mag. (WC)

• 

  Esophageal adenocarcinoma - intermed. mag. (WC)

Grading

Graded like other adenocarcinoma:

• >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:

• 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.

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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

• Esophagus.