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Esophageal adenocarcinoma (view source)
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'''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:Diagnosis]] | ||
[[Category:Esophagus]] | |||