Basic Pathology

ESOPHAGUS: Malignant Tumours - Large Cell Neuroendocrine

2009-12-07T08:14:00.000-08:00

Large Cell Neuroendocrine Tumour of the Esophagus

This is an extremely rare malignant esophageal tumour.
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Abstract:

Esophageal collision tumor (Large cell neuroendocrine carcinoma and papillary carcinoma) arising in a Barrett esophagus. Arch Pathol Lab Med. 2000 Mar;124(3):411-5.
We report herein a unique case of an esophageal collision tumor composed of a papillary adenocarcinoma and a large cell neuroendocrine carcinoma arising in a Barrett esophagus. Hematoxylin-eosin and silver staining patterns, immunohistochemistry,and electron microscopy of the large cell neuroendocrine component are discussed.

ESOPHAGUS: Malignant Tumours - Choriocarcinoma

2009-12-02T09:45:00.000-08:00

Choriocarcinoma of the Esophagus

Extragonadal germ cell tumours are rare neoplasms with histologic features similar to those of gonadal origin.

Extragonadal choriocarcinoma are known to be chemosensitive tumour. When the tumour arise within squamous cell carcinoma of the esophagus it may be chemoresistant.

A pure case of esophageal choriocarcinoma has a typical hemorrhagic and necrotic appearance occupying almost the entire circumference of the esophagus.

Germ cell differentiation may be difficult to identify in small biopsy samples, which may not be representative of the tumour as a whole.The finding of germ cell differentiation defines therapy and indicates a relatively good prognosis, which is contrast to adenocarcinoma. Because of the significance of germ cell differentiation in the selection of appropriate therapy, immunostaining for germ cell tumour markers is suggested in all patients with adenocarcinoma who are younger than 50 years.

The choriocarcinoma may metastasize to the liver, lung and lymph nodes.

In the esophageal tumour, immunohistochemical staining shows the presence of mainly human chorionic gonadotropin (HCG), with human placental lactogen (HPL) in a few syncytiotrophoblastic cells.

Abstract:

Choriocarcinoma - a rare association with squamous cell carcinoma of esophagus.Indian J Gastroenterol. 2006 Jan-Feb;25(1):42-3.
Extragenital choriocarcinoma involving the gastrointestinal tract is rare. We report a 60-year-old woman with squamous cell carcinoma of esophagus with a choriocarcinomatous focus. She was palliated with chemotherapy and an endoprosthesis.

Choriocarcinoma arising in a squamous cell carcinoma of the esophagus.Am J Clin Oncol. 2000 Apr;23(2):203-6.
Extragonadal germ cell tumors are rare neoplasms with histologic features comparable to those of gonadal origin. Squamous cell carcinoma of the esophagus was diagnosed in a 53-year-old male patient, and was palliated for a short period by cisplatin plus 5-fluorouracil. Clinical deterioration and development of gynecomastia led to diagnosis of hormone-secreting choriocarcinoma thatoriginated within the squamous cell tumor of the esophagus. Salvage chemotherapy affected the markers but not the tumor. Extragonadal choriocarcinoma is a chemosensitive tumor, but when arising within squamous cell carcinoma of the esophagus it may be chemoresistant, and lead to a fatal outcome.

Choriocarcinoma of the esophagus producing chorionic gonadotropin. Acta Pathol Jpn. 1988 Apr;38(4):489-99.
An autopsy case of primary esophageal choriocarcinoma in a 42-year-old Japanese male is reported. The tumor was pure choriocarcinoma typical hemorrhagic and necrotic nature occupying almost the entire circumference of the mid-esophagus.The choriocarcinoma had metastasized to the liver, lung and lymph nodes. In the esophageal tumor, immunohistochemical staining showed the presence of mainlyhuman chorionic gonadotropin (HCG), with human placental lactogen (HPL) in a few syncytiotrophoblastic cells. Only 3 cases of extragonadal choriocarcinomaoriginating in the esophagus have been reported up to now. The possible pathogenesis and pathological characteristics of primary esophagealchoriocarcinoma are discussed.

Choriocarcinoma of the esophagus: histologic and cytologic findings. A case report.Acta Cytol. 1979 Jan-Feb;23(1):69-74.
The present report is that of a 40-year-old woman admitted with hematemesis and epigastric pain. Endoscopy revealed a fungating mass in the lower esophagus.Esophageal brushing revealed clustered and single malignant cells with amplecytoplasm, large bizarre nuclei and prominent, irregular nucleoli; the chromatin was irregular with clumping at the nuclear borders. Giant multinucleated malignant cells were numerous. These cells had nuclear molding and abundant acidophilic cytoplasm. Autopsy findings included a large tumor in the loweresophagus and metastases to lung, liver and kidneys. Microscopically, the fungating esophageal tumor and metastases were composed of cyto- andsyncytiotrophoblastic elements. Choriocarcinoma of the esophagus is a rarity, and only two cases were found in the literature. The diagnosis, however, can be achieved by brush biopsy since the characteristic cyto- and syncytiotrophoblastic cells can be readily identified, provided that the possibility of this ectopic occurrence is recognized.

ESOPHAGUS: Malignant Tumours - Basaloid Squamous Cell Carcinoma

2009-12-01T11:06:00.000-08:00

Microscopic image of Basaloid Squamous Cell Carcinoma of the Esophagus

Basaloid Squamous Cell Carcinoma of the Esophagus
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Basaloid squamous carcinoma (BSC) is an uncommon variant of squamous cell carcinoma, with its prevalent sites being the hypopharynx, tongue base and larynx. Esophageal BSC is extremely rare, accounting for less than 2% of primary esophageal malignancies.

It is histopathologically distinct from squamous cell carcinoma and has an aggressive biological behavior with poor survival outcomes.

The tumour should be differentiated from adenoid cystic and small cell undifferentiated carcinoma.

Basaloid squamous cell carcinomas of the esophagus frequently have an intimate association with adenoid cystic carcinoma (ACC)-like patterns, but their histologic, immunocytochemical, and ultrastructural features correspond more to poorly differentiated squamous cell carcinoma than to salivary gland ACC. This distinction is important because genuine ACC is much less aggressive than BSC.

Histologically, most BSCs are composed of solid lobules or nests of basaloid cells with well-demarcated outlines surrounded by a fibrous stroma. There may be concomitant squamous cell differentiation, comedo-like necrosis in the basaloid carcinoma component of the tumor and hyaline degeneration within the stroma of the basaloid carcinoma nests (PAS+).
CK14 (some cells) , CK19, EMA, p53, AE1/AE3 and in some cases bcl2 are positive

S100 protein, smooth muscle actin and neuroendocrine markers are negative.

Abstract:

Basaloid squamous carcinoma of esophagus:a clinicopathological,immunohistochemical and electron microscopic study of sixteen cases.World J Gastroenterol. 1998 Oct;4(5):397-403.
AIM:To further clarify the clinicopathological, immunohistochemical and electron microscopic features, and prognostic aspect of basaloid squamous carcinoma (BSC),a rare esophageal carcinoma.METHODS:We reviewed 763 documented cases ofesophageal malignancies from year (1977-1996) from our hospital, and discovered16 (2.1%) cases of BSC. The clinicopathological features of these cases wereevaluated. Immunohistochemistry (S-P method), histochemical stains, and electron microscopy were used to further characterize the neoplasm.RESULTS:The tumors wereclassified into stages I(n =1), II A (n =6), II B(n =2), II (n =5), and IV(n =2) according to the criteria of the UICC TNM classification system of malignanttumors (1987). Most neoplasms were located in the mid third of the esophagus.Grossly, they had a similar appearance of conventional esophageal carcinoma, but showed a typical cytoarchitectural pattern of BSC histologically. The most important histologic feature of this tumor is carcinoma with a basaloid pattern, intimately associated with squamous cell carcinoma, dysplasia, or focal squamous differentiation. The basaloid cells were round to oval in shape with scant cytoplasm, arranged mainly in the form of solid, smooth-contoured lobules with peripheral palisading.A panel of immunostains were used for the basaloidcomponent of the tumor with the following results:CK(Pan) 14/16(+); EMA 16/16(+); Vimentin 4/16 (+); S-100 protein 7/16 (+). CEA and smooth muscle actin were negative. Electron microscopy (EM) revealed that the basaloid cells were poorlydifferentiated, with a few desmosomes and fibrils, and numerous free andpolyribosome. Of the 11 patients with adequate follow-up 8 died within 2 years,with an average survival time of 16.2 months. No stage II,III or IV cases survivedbeyond 5 years. The one-year survival rate was 60% and two-year 20%.CONCLUSION:The BSC of esophagus is a distinct clinicopathological entity withpoor prognosis. The cellular differentiation and biologic behavior of esophageal BSC were assumed to occupy a station intermediate between that of conventional squamous cell carcinoma and small undifferentiated cell carcinoma.

Basaloid squamous cell carcinoma of the esophagus: assessment for high-risk humanpapillomavirus and related molecular markers. Am J Surg Pathol. 2009 Nov;33(11):1608-14.
Basaloid squamous cell carcinoma (BSCC) of the esophagus is rare, historicallyconfused for adenoid cystic carcinoma, and recently shown to behave similar toconventional, keratinizing esophageal squamous cell carcinoma. At other sites (eg, oropharynx, anogenital tract) the basaloid phenotype is frequently associated with the presence of high-risk human papilloma virus (HPV). HPVs role in esophageal squamous cell carcinomas is less certain, and to our knowledge, adirect examination of esophageal BSCC for high-risk HPV has not been performedearlier. Nine cases of esophageal BSCC were retrieved from our surgical pathology files. Twenty-two cases of keratinizing esophageal squamous cell carcinoma servedas controls. In situ hybridization (ISH) for high-risk HPV and immunohistochemistry for related molecular markers including p53, cyclin D1, and p16 (scored 0 to 4+ based on percentage of cells staining; p53 additionally scored for intensity) were performed. HPV ISH was nonreactive in all tested cases. Compared with controls, BSCC showed less immunoreactivity for p16 and p53 (P=0.003, 0.009). Esophageal BSCC is negative for high-risk HPV by ISH, distinguishing these lesions from other BSCCs. Differential p16 and p53 expression in BSCC suggests that these tumors are molecularly distinct from conventional esophageal squamous cell carcinomas.

Histological diversity in basaloid squamous cell carcinoma of the esophagus. Dis Esophagus. 2009;22(3):231-8. Epub 2008 Oct 10.
Basaloid squamous cell carcinoma of the esophagus (BSCCE) is a distinct variantof esophageal cancer. This study investigated histopathological variations ofBSCCE. Thirty-eight surgical and two endoscopically resected specimens of BSCCEwere examined. Histological features were classified into five components: solid nest (SN), microcyst and/or trabecular nest (MT), ductal differentiation (DD), cribriform pattern (CP), and an invasive squamous cell carcinoma (SCC) component.The immunohistochemical phenotypes of each component were examined usingantibodies against cytokeratin (CK) 7, CK14, and alpha smooth muscle actin (SMA).SN, MT, DD, CP, and SCC were present in 95.0, 97.5, 27.5, 32.5, and 82.5% of the cases, respectively, and combinations of SN & MT, SN & DD, SN, MT & DD, SN, MT & CP, and SN, MT, DD & CP were found in 50.0, 2.5, 10.0, 17.5, and 15.0%,respectively. All the intraepithelial lesions observed in 18 (45.0%) cases wereSCC. Immunoreactivity for CK7, CK14, and SMA was seen in 10.5, 86.8, and 18.4% ofSN; 30.8, 97.4, and 38.5% of MT; 54.5, 100.0, and 54.5% of DD; 7.7, 76.9, and23.1% of CP; and 6.1, 97.0, and 0.0% of SCC, respectively. CK14 immunoreactivity was seen in the periphery of most of the SN component. CK7, CK14, and SMAimmunoreactivity was seen in the inner layer, all layers, and the outer layer of DD, respectively. MT and CP showed partial peripheral positivity for CK14 and SMA in microcystic, trabecular, and cribriform-like pseudoglandular structures. BSCCE demonstrates various histopathological and immunohistochemical features including a ductal and cribriform growth pattern.

Basaloid squamous cell carcinoma of the esophagus: report of two cases. J Nippon Med Sch. 2008 Dec;75(6):354-60.
Basaloid squamous cell carcinoma is an uncommon malignancy of the esophagus. We present two cases of basaloid squamous carcinoma of the esophagus. Both tumors histologically consisted of solid cell nests and displayed focal immunoreactivity for type IV collagen. The nests comprised pseudoglandular structures containing myxoid matrix. Transthoracic esophagectomy with lymph node dissection was performed in both patients. The patients had uneventful postoperative courses. One patient showed no evidence of recurrence or metastasis in the 6-month postoperative period, and the other patient died of lung metastasis 28 months after the primary treatment.

Superficial basaloid squamous carcinoma of the esophagus. A clinicopathological and immunohistochemical study of 12 cases. Pathol Res Pract. 2003;199(11):713-21.
Basaloid squamous carcinoma (BSC) is a rare variant of squamous cell carcinoma(SCC). In this study, clinicopathological and immunohistochemical characteristicsof 12 superficial esophageal BSCs were examined and compared with those oftypical superficial SCCs. Eight cases were classified into an elevated type, and the other four into a depressed type. High-grade intraepithelial neoplasia was not observed around the invasive lesions in five cases, and only BSC componentswere apparent. High-grade intraepithelial neoplasia was demonstrated in sevencases, five of which had both BSC and SCC components in the invasive lesion. A cribriform growth pattern, comedo-type necrosis, and hyaline deposits wereconspicuous histological findings. CK14 was positively stained in 90% of theseries, but the proportion of positive cells was small in most cases. Type IV collagen was increased or well preserved in the basement membrane in 70% ofcases, but heparan sulfate was decreased in the majority. In comparison with SCCs, lymphatic permeation was observed less frequently. However, regarding the frequencies of venous permeation, nodal metastasis, p53 protein expression, and Ki-67 labeling index, no significant differences were noted. Thus, esophageal BSCs demonstrate the pathological features characteristic of an early stage, but pathological parameters related to biological behavior do not significantly vary from those typical of SCCs.

Esophageal basaloid carcinoma with marked myoepithelial differentiation.Pathol Int. 2002 Apr;52(4):313-7.
A case of esophageal basaloid carcinoma with marked myoepithelial differentiationin a 60-year-old man is reported. The tumor arose as an exophytic mass, measuring 65 x 60 mm, in the middle thoracic esophagus. Approximately two-thirds of thetumor surface was covered with non-cancerous esophageal epithelium. The depth of tumor invasion was limited to the submucosal layer. Histologically, about 70% of the tumor contained a typical basaloid carcinoma component and about 30%contained glandular and intercalated duct-like components with distinct epithelial and myoepithelial differentiation. The tumor presented no component of distinct squamous cell carcinoma, but a small portion of cribriform-likestructure, which is typical of adenoid cystic carcinoma, was visible. The innerepithelium composing the intercalated duct-like structure showed immunohistochemical positivity for cytokeratin 14, and the outer epitheliumlining adjacent to the stroma showed positivity for alpha-smooth muscle actin.These findings supported epithelial/myoepithelial differentiation. To our knowledge, our case is the first patient with an esophageal basaloid carcinoma showing marked myoepithelial differentiation.

Basaloid squamous cell carcinoma of the esophagus: diagnosis and prognosis. Cancer. 1997 May 15;79(10):1871-8.
BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is a recently recognized, poorly differentiated variant of squamous cell carcinoma (SCC), which is located predominantly in the upper aerodigestive tract. METHODS: In this study, clinical and pathologic parameters of 17 BSCCs and 133 typical SCCs of the esophagus that underwent potentially curative resection (no distant metastases, no residualtumor) were compared. In addition, light microscopic, electron microscopic, andimmunohistochemical features of BSCC were investigated, to determine whether this type of carcinoma could be differentiated from other poorly differentiatedcarcinomas of the esophagus. RESULTS: Light microscopic study showed that BSCC was composed of relatively small tumor cells, arranged in solid lobules with abundant comedo-type necrosis. BSCC was almost invariably accompanied by areas of concomitant typical SCC, foci of squamous cell differentiation, and/or severesquamous cell dysplasia or carcinoma in situ of the adjacent mucosa. Ultrastructurally, BSCC inconsistently showed features of squamous celldifferentiation. Immunohistochemically, BSCC displayed poor reactivity for antibodies against wide-range cytokeratins and cytokeratin subtypes that are typical of squamous cell epithelia (cytokeratin 13 and cytokeratin 14). Infrequently, expression of Leu7, smooth muscle actin, and S-100 protein was found. In comparison with typical SCC, the characteristic features of BSCC wereolder patient age, higher proliferative activity (MIB-1 labelling index), and higher apoptotic indices. No differences were found with regard to pTclassification, pN classification, tumor size, blood vessel invasion, lymphaticvessel invasion, neural invasion, or patient gender. Moreover, no differences in overall survival rates were found. CONCLUSIONS: BSCC is a distinct histopathologic variant of SCC, characterized by a poor degree of differentiationand high proliferative activity. However, after potentially curative resection,the prognosis of patients with BSCC of the esophagus does not differ from that of patients with typical SCC.

ESOPHAGUS: Malignant Tumours - Adenosquamous Carcinoma

2009-11-30T11:43:00.000-08:00

Adenosquamous Carcinoma of the Esophagus

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This carcinoma is a typical neoplasm of the upper aerodigestive tract almost exclusively originating in squamous epithelium in continuity with minor salivary glands.
It is a very rare tumour in the esophagus, and is often diagnosed as mucoepidermoid carcinoma. The differential diagnosis between them is important due to the better prognosis of the latter entity.
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Abstracts:
A case of esophageal adenosquamous carcinoma.
Adenosquamous carcinoma in Barrett's esophagus presenting as pseudoachalasia.
Polypoid adenosquamous carcinoma of the esophagus with prominent spindle cells : report of a case with immunohistochemical and ultrastructural studies.
Adenosquamous carcinoma of the esophagus. Clinicopathologic study of 18 cases.Oncology. 2004;66(3):218-25.
OBJECTIVES: Adenosquamous carcinoma (ASC) of the esophagus is an uncommon form ofesophageal cancer. Despite isolated case reports on this tumor type, no largeclinicopathologic series appears to have been studied at a single institution.METHODS: At our institution, 20 cases of ASC were diagnosed pathologicallybetween 1970 and 2001 (20/2,056 total esophageal cancers; 1.0%). Excluding 2patients who received preoperative radiation therapy, 18 were selected for reviewof their clinicopathologic features, including survival time, in comparison with those of patients with conventional squamous cell carcinomas (SCCs; n = 850) and adenocarcinomas (ACs; n = 40) of the esophagus. RESULTS: The location andmacroscopic type of the ASCs were similar to those of the SCCs. ASC tumors weresignificantly smaller than SCC (p = 0.004) and AC (p = 0.012) tumors, and thedepth of invasion of ASCs was significantly less than that of SCCs (p = 0.028).Lymphatic permeation and blood vessel invasion were seen in 14 (77.8%) and 7(38.9%) of the 18 patients with ASCs, respectively, and intraepithelial carcinomacontiguous to the main lesion was evident in 10 cases (56.6%). The cumulativepostoperative survival rates of patients with ASC at 3, 5 and 10 years were 71.5,63.6 and 47.7%, respectively, the outcome being significantly better than forpatients with either SCC (p = 0.027) or AC (p = 0.013). CONCLUSION: In theesophagus, ASCs have better prognosis than conventional SCCs or ACs, probably due to their smaller size and lower stage.

Adenosquamous carcinoma arising in Barrett's esophagus.Jpn J Thorac Cardiovasc Surg. 2002 Dec;50(12):537-40.
Primary adenocarcinoma of the esophagus is rare in Japan and, in most cases,arises from Barrett's esophagus epithelium. A 72-year-old man reporting heartburnand dysphagia and preoperatively diagnosed with adenosquamous carcinoma arisingfrom Barrett's esophagus underwent thoracic esophagectomy and lymph nodedissection in curative resection. Pathological diagnosis of the resected specimenshowed adenosquamous carcinoma (coexistent adenocarcinoma and squamous cell carcinoma) invasive to the submucosal layer; metastasis was found in regional lymph nodes. Pathological staging was pT1bN1M0, stage II. Unfortunately, the man died of liver and lung metastasis 17 months postoperatively. To our knowledge,this rare case is only the fifth reported in the English literature on adenosquamous carcinoma arising from Barrett's esophagus.

ESOPHAGUS: Malignant Tumours - Adenoid Cystic Carcinoma

2009-11-30T09:14:00.000-08:00

Adenoid Cystic Carcinoma of the Esophagus

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Adenoid cystic carcinoma (ACC) is typically a salivary gland tumor.

However, this tumour can present in the esophagus.

This rare cancer of the esophagus has occurred in persons aged 36 to 83 with a mean age prevalence in the early to mid-60s.

It occurs in men 2.5 to 4.3 times more commonly than in women.

Patients often give history of tobacco.

Most patients with adenoid cystic carcinoma of the esophagus present with dysphagia, but other presentations include retrosternal chest pain, nausea and vomiting.

Microscopic features:

The tumour cells presented three distinct patterns: globular nest with irregular cystic spaces, trabecular nest, and true tubule.

In the literature adenoid cystic carcinoma are frequently associated with epithelial abnormalities.

ACC often shows cribiriform pattern and high mitotic activities, excluding typical cribriform pattern in ACC of the salivary gland. Inaddition to these features, the presence of foci of squamous cell carcinoma is occasionally found and positive immunoreactivities for S-100 and actin are recognized. Therefore, the immunohistochemical staining is useful for distinction among ACC and other tumors.

[Note: Ductal cells are CEA, cytokeratin positive and basal cells are S100 protein and actin positive.]

The main differential diagnosis is basaloid squamous cell carcinoma.

A number of reported cases of ACC had diffuse metastasis on presentation, usually to the lymph nodes, liver, lung, or brain.

The prognosis of adenoid cystic carcinomas is not well known, but the treatment and prognosis appear similar to those of epidermoid carcinomas of the esophagus.

Abstracts:

Primary adenoid cystic carcinoma of esophagus. Rev Gastroenterol Peru. 2008 Jan-Mar;28(1):50-5.
We presented the case of a man of 86 years with 6 months of progressive dysphagia, weight loss and edema of lower limbs. He had both severe microcític anemia and hypoalbuminemia. The contrasted x-ray showed the esophagus with irregular edges that compromised their cervical and distal portions. In the computerized axial tomography cervical adenopathies, bilateral pleural effusion and pronouncing esophagic thickening were evident. In endoscopy dispersed elevated lesions were observed from the underlying area of the cricopharinx, some with nodular and tumor like aspect, that distributed throughout the esophagus until an area of stenosis (32 cm of dental arches); the estenosis was tapestried with an irregular and easy bleeding mucosa. The histological study revealed adenoid cystic carcinoma of esophagus, with positive inmunocytochemical to cytokeratin. We showed the clinical-pathological findings and images of this case and we reviewed reports of this rare entity.

Adenoid cystic carcinoma of the esophagus: report of a case. Surg Today.1997;27(3):238-42.
The case of a 70-year-old Japanese woman with adenoid cystic carcinoma (ACC) of the esophagus is presented herein. The patient presented with progressive dysphagia, and an upper gastrointestinal series and esophagogastroscopy revealed a protruding tumor located in the middle portion of the esophagus. Ultrasonography (US) and computed tomography (CT) suggested a lymph node metastasis between the left lobe of the liver and the esophagocardiac junction. Histopathologic examination of a biopsy specimen showed squamous cell carcinoma (SCC) and a subtotal esophagectomy was performed under the preoperative diagnosis of esophageal carcinoma. However, the histopathologic diagnosis of the resected specimen proved to be ACC of the esophagus with a lymph node metastasis around the left gastric artery. We report the clinicopathological findings of this case and briefly discuss the clinical implications of ACC.

Adenoid cystic carcinoma of the esophagus.Gan No Rinsho. 1986 Oct;32(12):1582-90.
A 56-year-old man was admitted with the complaint of dysphagia. X-ray studies and endoscopy revealed a protruding tumor at the middle third of esophagus. Under the diagnosis of esophageal cancer, subtotal esophagectomy was performed. A Borrmann type I like tumor measuring 6.7 X 3.8 X 2.2 cm was identified on the resected specimen. The surface of the tumor was irregular, nodular and covered with thin compressed esophageal mucosa. The histology of the tumor was consistent with adenoid cystic carcinoma. Incidentally, small foci of invasive squamous cell carcinoma were found adjacent to this tumor. There was no lymph node or remote organ metastasis.
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ESOPHAGUS : Malignant Tumours - Adenocarcinoma

2009-11-23T12:17:00.000-08:00

Adenocarcinoma:
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- Adenocarcinoma accounts for about 5% of esophageal cancers.
- Adenocarcinoma appears to evolve through dysplastic change in Barrett's mucosa.
- Genetic alterations are well documented.
- Gross appearance:
i) The vast majority arise from Barrett's mucosa in areas of dysplasia. Most of these are located in the distal third of the esophagus.
ii) It may be exophytic nodule or excavated and deeply infiltrative lesion.
- Microscopic features:
These are mucin-producing glandular tumours with intestinal features or diffusely infiltrative signet ring cells, rarely, adenosquamous or small cell type.
- Clinical features:
i) Tumours arise in Barrett's mucosa in patients older than 40 years of age. These are more commonly noted in men than in women, with symptoms as in squamous cell carcinoma.
ii) Previous symptoms of gastroesophageal reflux are present in fewer than half of patients.
iii) Overall 5-year survival is less than 30%.
iv) Screening programs detect disease at an earlier stage.

ESOPHAGUS : Malignant Tumours - Squamous cell carcinoma:

2009-11-23T12:14:00.000-08:00

Microscopic Image of Esophageal Squamous Cell Carcinoma

Squamous cell carcinoma: (Visit:Pathology of Esophageal Squamous Cell Carcinoma)
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- Over 90% of the cancers of the esophagus are squamous cell carcinomas and occurs in adults older than 50 years of age. These are more often noted in men.
- Incidence varies among geographic areas, with highest incidence in Northern China, Iran, Russia, and South Africa.
- Pathogenesis:
i) Pathogenesis is multifactorial, with synergistic interaction of environmental and dietary factors, (e.g. lacking in fresh fruits, vegetables and animal proteins, perhaps modified by genetic factors).
ii) Other important contributory factors include:
- Nutritional deficiency associated with lack of fresh fruits and vegetables.
- Deficiency of trace material.
- Vitamin deficiency like A, C, riboflavin etc.
- Regular ingestion of fermented vegetables.
- Regular intake og fot food and beverages.
- Smoking, chewing tobacco and betel nuts.
- Radiation.
- Chronic esophagitis, achalasia.
- Plummer Vinson syndrome.
- Chronic injury to the esophagus.
iii) Any condition associated with chronic injury to the esophageal mucosa predisposes to squamous cell carcinoma of the esophagus.
- Lesions:
i) Squamous cell carcinomas begin as in-situ lesions : Gray-white, plaque-like thickenings or elevations of mucosa.
ii) Gradually, the lesions extend longitudinally along axis, circumferentially, and deep (with invasion).
iii) Distribution of lesions :
a) Upper thirds of esophagus-20%
b) Middle thirds of esophagus-50%
c) Lower thirds of esophagus-30%
iv) Gross appearance
a) Polypoid type (60%) - projects into the lumen and tend to obstruct early.
b) Ulcerating type (25%) - excavates deeply into the surrounding structures and
tends to bleed.
c) Diffuse infiltrative type (15%) - gradually narrows the lumen
v) Microscopic features:
a) Early, superficial carcinoma shows invasion no deeper than submucosa.
b) Usually moderately to well differentiated, with or without keratinization.
- Spread:
Esophagus has rich lymphatic drainage hence the tumour spreads via lymphatics to nearby lymph nodes:
a) From upper third-cervical nodes.
b) From middle third-mediastinal, paratracheal and tracheobronchial nodes.
c) From lower third- gastric and celiac groups of nodes.
- Clinical features:
i) The most common presenting complaint is dysphagia, which develops only when the diameter of the lumen of the esophagus is reduced by 30% to 50%.
ii) Persistent pain suggests mediastinal extension of the tumour or involvement of spinal nerves.
iii) Compression of the recurrent laryngeal nerve produces hoarseness.
iv) Other symptoms are weight loss, hemorrhage, sepsis secondary to ulceration.
v) Tracheo-esophageal fistula is manifested clinically by a chronic cough.
- Prognosis:
i) Curative resection is possible in 80% of cases.
ii) Five years survival:
a) Superficial lesion 75%
b) Advanced resectable lesion 25%
c) All patients with esophageal cancer 5%

ESOPHAGUS : Malignant Tumours

2009-11-23T12:10:00.000-08:00

Malignant Tumours: Visit: Esophageal Pathology
Esophageal cancer is the third most common gastrointestinal cancer and ranks among the ten commonest cancers worldwide. The tumour cause disproportionately high death rate - (squamous cell carcinomas- 90% ; Adenocarcinoma- 5%)

Rare cancers of the esophagus include small-cell carcinomas, squamous cell carcinomas with sarcomatous features, squamous cell-superficial, verrucous , adenoid cystic carcinomas, adenosquamous, large cell neuroendocrine, lymphoepithelioma-like, metastases, Paget’s disease , pleomorphic giant cell , and mucoepidermoid carcinomas. Basaloid squamous cell carcinoma is a distinct clinicopathological entity, seen more frequently in elderly males.
Other malignant tumours include carcinoid, Ewing’s sarcoma, gastrointestinal stromal tumour (GIST), hemangiopericytoma, Kaposi’s sarcoma, leiomyosarcoma, liposarcoma, lymphoma, malignant peripheral nerve sheath tumour (MPNST), melanoma, osteosarcoma.

ESOPHAGUS : Benign Tumours

2009-11-20T09:38:00.000-08:00

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Images1 to 5 : Microscopic images of Inflammatory Fibroid Polyp of the Esophagus.

Microscopic image of Fibrovascular Polyp of the Esophagus

Microscopic image of Glycogenic Acanthosis of the Esophagus

Microscopic image of Squamous Papilloma of the Esophagus

Benign Tumours:

i) Intramural or submucosal : Leiomyoma, fibroma, lipoma, hemangioma, neurofibroma, lymphangioma.

ii) Mucosal : Squamous papilloma, fibrovascular polyp (with overlying epithelium), inflammatory polyp (severely inflamed mesenchyme with overlying epithelium).

1. SQUAMOUS PAPILLOMA OF THE ESOPHAGUS
2. INFLAMMATORY FIBROID POLYP OF THE ESOPHAGUS
3. LEIOMYOMA OF THE ESOPHAGUS
4. GRANULAR CELL TUMOUR OF THE ESOPHAGUS
5. ESOPHAGEAL CYSTS
6. GLYCOGENIC ACANTHOSIS
7.FIBROVASCULAR POLYPS

ESOPHAGUS : Varices

2009-11-20T09:20:00.000-08:00

Varices:
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- Varices occur in 90% of cirrhotic patients, especially alcoholics. Hepatic schistosomiasis is
a common cause worldwide.
- Prolonged and severe portal hypertension induces formation of collateral by-pass channels wherever the portal and vena-caval systems communicate.
i) In esophagus - collaterals develop in the lower esophagus, where portal flow is diverted through the coronary veins of the stomach into the plexus of esophageal subepithelial and submucosal veins (varices) and then to the azygos veins and eventually into systemic circulation. ii) Other porto-systemic shunts include:
a) The rectal canal (hemorrhoids) and
b) Falciform ligament (caput medusae).
- Lesions:
i) Tortuous dilated veins are seen, lying primarily within submucosa of distal esophagus and proximal stomach with irregular protrusion of overlying mucosa into lumen.
ii) Superficial ulceration, inflammation, or adherent blood clot may be present.
- Clinical features:
i) Varices are silent until ruptures with catastrophic hematemesis, fatality rate is 40% for each episode of bleeding with a 90% chance of recurrence within a year in survivors.
ii) Massive hematemesis in patients with varices may also be caused by gastritis, esophageal laceration, or peptic ulcer.
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ESOPHAGUS : Barrett's Esophagus

2009-11-20T08:40:00.000-08:00

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Images1 to 4 : Barrett's esophagus with low grade dysplasia

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Images5 to 7 :Barrett's esophagus with villiform intestinal metaplasia

Image: Barrett's esophagus shows ulceration and stricture at gastro-esophageal junction.

Barrett's Esophagus: Image Link
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- Barrett's esophagus is defined as replacement of the squamous epithelium in the lower
third of the esophagus by a metaplastic columnar epithelium.
- In most cases it occurs in response to chronic reflux esophagitis.
- It is most common in adults but may be seen in children and infants.
- Pathogenesis:
i) Long-standing gastroesophageal reflux leads to inflammation and ulceration of squamous mucosa,
ii) Healing is by re-epithelialization by pleuripotent stem cells, which in the setting of low pH differentiate into more resistant gastric type or intestinal type epithelium.
- Grossly, it shows red velvety mucosa existing as an irregular circumferential band at the
gastroesophageal junction, linear streaks, or patches in the distal esophagus. Image Link
- Microscopic features:
i) There is a mixture of gastric-type and intestinal-type columnar epithelial cells (mucin-secreting and absorptive). The villi are lined with intestinal goblet cells and sometimes Paneth cells.
ii) In some cases gastric epithelium with parietal and chief cells are found.
- Prognosis:
i) Substantial risk of ulceration and stricture exists.
ii) Risk of adenocarcinoma is 30 times more than normal.
Image Link

ESOPHAGUS : Esophagitis

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Image: Candidiasis (thrush) of the esophagus. A ‘pseudomembrane’ is present (top) on the surface of the stratified squamous epithelium. It consists of desquamated epithelial cells and thin filament-like fungi. The fungi has penetrated the superficial layer of the squamous epithelium which is separated from relatively unaffected basal layer.

Esophagitis : Image Link ; Image Link

Causes of esophagitis include:
i) Reflux esophagitis, via reflux of gastric contents.
ii) This is due to the decreased efficacy of esophageal anti-reflux mechanisms
iii) Prolonged gastric intubation.
iv) Ingestion of irritants, such as alcohol, corrosive acids or alkalis (in suicide attempts),
v) Excessively hot fluids (i.e. hot tea in Iran), and heavy smoking.
vi) Cytotoxic anti-cancer therapy, with or without superimposed infection.
vii) Infection following bacteremia or viremia- (e.g. herpes simplex virus ; cytomegalovirus).

viii) Fungal infection ( e.g. candidiasis, mucormycosis, aspergillosis). Image Link
ix) Ureamia
x) Radiation
iv) Hypothyroidism, systemic lupus erythematosus (SLE), and pregnancy cause decrease lower esophageal sphincter(LES) tone.
v) Presence of sliding hiatus hernia.
vi) Delayed gastric emptying and increased gastric volume.

Reflux Esophagitis

- Reflux esophagitis results from the regurgitation of gastric contents into the lower esophagus.

- Morphologic findings (from mild to severe) include:

i) Hyperemia and edema,
ii) Thickening of basal zone and thinning of superficial layers of stratified squamous epithelium,
iii) Polymophonuclear or eosinophilic leukocyte infiltration,
iv) Superficial necrosis and ulceration with adherent inflammatory exudates.

Infectious and Chemical Esophagitis

Unusual causes of esophageal mucosal inflammation include the following:
1. Prolonged gastric intubation.
2. Ingestion of irritants : alcohol, corrosive acids or alkalis, excessively hot fluid, smoking.
3. Uremia
4. Bacteremia or viremia(e.g: herpesvirus, cytomegalovirus infection).
5. Fungal infection: (e.g: candidiasis, mucormycosis, aspergillosis).
6. Radiation

7. Cytotoxic anticancer therapy.
8. Systemic desquamative disorders: pemphigoid, epidermolysis bullosa.
9. Graft-versus host disease.

ESOPHAGUS : Lacerations and Mallory-Weiss Syndrome

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Lacerations:

- Lacerations of the esophagus result from external trauma, such as automobile accidents and fall from great heights, and from medical instrumentation.
- Most common cause of laceration is severe vomiting leading to high intraesophageal pressure.
- The diaphragm descends rapidly and a portion of the upper stomach is forced up through the hiatus.
- Forceful stretching may cause mucosal tears, beginning in the gastric epithelium and extending into the esophagus.

Mallory-Weiss Syndrome: Image Link
Image Link
- In Mallory-Weiss syndrome lacerations are longitudinal tears in the esophagus at the esophagogastric junction, attributed to episodes of excessive vomiting in the setting of toxic gastritis, with failure of lower esophageal sphincter relaxation.
- Lacerations are most frequently seen in alcoholics.
- They may lead to potentially massive hematemesis, inflammation, residual ulcer, mediastinitis, or peritonitis.
Image Link(emedicine)

Lesions:
- Irregular longitudinal tears span the esophagogastric junction, several milimeter to centimeter in length.
- Lacerations may involve only mucosa or rarely, may penetrate the wall.

Clinical features:
- Lacerations account for 5% to 10% of upper gastrointestinal bleeding events.
- Lacerations are not usually fatal, and healing tends to be prompt.

ESOPHAGUS : Diverticulum

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Diverticulum:

A diverticulum is an outpouching of the alimentary tract that contains one or more layers of the wall. Image Link
Esophageal diverticula are classified as follows:
i) Pharyngeal (Zenker's) diverticulum- Located in the upper esophagus. It is presumed that this type of diverticulum is formed as a result of motor dysfunction. Image Link
ii) Traction diverticulum - More distal location, attributed to fibrosing mediastinal
processes or abnormal motility.
iii) Epiphrenic diverticulum - Located immediately above esophageal sphincter. The cause is unclear.
Image Link

ESOPHAGUS : Hiatal Hernia

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Hiatal Hernia

Image Link ; Image Link
- Hiatal hernia refers to a saclike dilation of stomach with protrusion above the diaphragm, with separation of the diaphragmatic crura and widening of the esophageal foramen.
- Two basic types are:
i) Sliding (axial) hiatal hernia - 90% of cases : Image Link
Shortened esophagus causes traction of upper stomach into thorax forming bell-like dilation of stomach within the thoracic cavity.
Most of these cases are asymptomatic.
Only 5% of the patients are diagnosed radiologically for complaint of symptoms referable to gastro-esophageal reflux.
ii) Paraesophageal hiatal hernia (rolling hernia) - less than10% of cases: Image Link
a) This is characterized by herniation of a portion of the gastric fundus alongside the esophagus through a defect in the diaphragmatic connective tissue membrane that defines the esophageal hiatus.
b) The hernia progressively enlarges, and the hiatus grows increasingly wide.
c) As a result in extreme cases most of the stomach may herniate into the thorax.
d) Most large para-esophageal hernias do not cause significant symptoms.
- Clinical features:
i) Symptoms are heart burn and regurgitation due to gastroesophageal reflux.
ii) Dysphagia (painful swallowing) is not uncommon.
iii) Large para-esophageal hernia with protrusion of the stomach into the thorax may embarrass respiration. In large herniations there is a risk of gastric volvulus, or strangulation causing bleeding or perforation.
iv) Sliding hiatal hernias are usually treated medically.
vi) An enlarging paraesophageal hernia should be surgically repaired even in the absence of symptoms.
Image Link

ESOPHAGUS : Achalasia

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Achalasia:

- Achalasia is a disease characterized by the absence of peristalsis in the body of the esophagus

- Three features are present in achalasia:
i) Aperistalsis of the esophagus
ii) Partial or incomplete relaxation of the lower esophageal sphincter with swallowing.
iii) Increased resting tone of the lower esophageal sphincter.

- Secondary features are proximal esophageal dilation, dysphagia, and regurgitation.
- Clinically, achalasia presents in young adulthood or earlier and is problematic throughout life.
- The risk of esophageal carcinoma is 2% to 7%.
- Other complications include candidial esophagitis, diverticula, and aspiration pneumonia.
- Manometry shows aperistalsis, impaired relaxation of the lower esophageal sphincter, and increased lower esophageal sphincter resting tone.

- Morphological features include the following: Image Link

i) Dilated esophagus above the lower esophageal sphincter.
ii) Thickened (muscular hypertrophy) or thinned (distention) muscular wall.
iii) Diminished myenteric ganglia.
iv) Secondary mucosal damage.

Secondary Achalasia:
- Secondary achalasia occurs with Chagas disease (Trypanosoma cruzi destroys ganglion cells),
- Disorders of the vagal dorsal motor nuclei (polio, surgical ablation),
- Diabetic autonomic neuropathy, and
- Infiltrative disorders (malignancy, amyloidosis, sarcoidosis).

ESOPHAGUS : Congenital Anomalies - Stenosis, Webs, and Rings

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Stenosis ; Webs ; and Rings

Stenosis:

- This may be congenital or acquired in adult life after severe esophageal injury(gastroesophageal reflux, radiation, scleroderma, or caustic injury).
- Clinical features of esophageal narrowing include progressive dysphagia, especially to solid foods.

Webs:

Esophageal webs are thin mucosal membranes with a vascularized fibrous core, projecting into the esophagus and are seen in the upper part of the esophagus.

Plummer-Vinson syndrome:(Paterson-Kelly syndrome) is characterized by:

i) A cervical esophageal web,
ii) Mucosal lesions of the mouth and pharynx and
iii) Iron-deficiency anemia

Schatzki Rings:

- These are the mucosal membranes at the lower part of esophagus, at the gastroesophageal junction.
- These are usually present in adult life.
- Microscopically, the upper surface of the mucosal ring exhibits stratified squamous epithelium, while the lower surface is lined by a columnar epithelium.

ESOPHAGUS : Congenital Anomalies - Atresia and Tracheoesophageal Fistulas

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Atresia and Tracheoesophageal Fistulas:

Image Link
- Esophageal atresia is a congenital anomaly of the upper gastrointestinal tract in which the continuity between the upper and lower esophagus is lost.
- It can occur with or without tracheoesophageal fistula.
- Atresia and fistulas are uncommon. These are usually discovered soon after birth.
- Many cases are incompatible with life, often associated with congenital heart disease and other gastrointestinal tract malformations.
- Clinical manifestations include excessive oral secretions, coughing, gagging, cyanosis, vomiting, and/or respiratory distress.
- In esophageal atresia, a segment of the esophagus is only a thin, noncanalized cord, with blind pouches on either side.
- In most cases, the upper esophagus ends and does not connect with the lower esophagus and stomach.
- In 80% of cases, a fistula connects one of the pouches (the top end of the lower esophagus) with the trachea or with mainstem bronchus.
- Tracheoesophageal fistula is an abnormal connection between the trachea and the esophagus.
Image Link
Image Link

ESOPHAGUS : Anatomy and Physiology

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Image: Normal esophageal mucosa

Image: Gastro-esophageal junction

Visit: Normal histology of Esophagus

Anatomy and Physiology of Esophagus:

- The adult esophagus is a 25 cm-long tube and is fixed superiorly at the cricopharyngeus muscle, which is considered as the upper esophageal sphincter.
- Esophagus courses inferiorly through the posterior mediastinum behind the trachea and the heart and exits the thorax through the hiatus of the diaphragm.
- The so-called lower esophageal sphincter (LES) is not a true anatomic sphincter, but rather a functional one.
- Tonic muscular contraction at the lower end of the esophagus creates an action similar to that of a one-way flutter valve.
- The transition from the normal squamous mucosa of the esophagus to the gastric mucosa at the esophago-gastric junction occurs abruptly at the level of the diaphragm.
- The venous drainage of the esophagus is important in portal hypertension because it forms esophageal varices.
- The functions of the esophagus include:
i) Esophagus conducts food and fluids from the pharynx to the stomach and
ii) Prevents reflux of gastric contents into the esophagus.
- These functions require coordinated motor activity including both extrinsic and intrinsic innervation, myogenic properties and humoral substances.

Clinical features of esophageal dysfunction include:
1. Dysphagia- is the difficulty in swallowing due to mechanical and functional disorders.
2. Heartburn- is the retrosternal burning pain. It is usually due to regurgitation of gastric contents into lower esophagus.
3. Hematemesis- is the vomiting of blood due to inflammation or ulceration or rupture of blood vessels.

GASTROINTESTINAL TRACT : Mechanism of digestion and absorption

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Mechanism of digestion and absorption:

i) Fat
ii) Protein
iii) Carbohydrate
iv) Others: vitamin-B12, Iron, Calcium etc.

Fat metabolism:

I) Diet consisting of triglycerides (Tg) are imulsified mechanically in the stomach and in the intestine by bile acids.
II) Pancreatic lipase hydrolyses Tg to monoglyceride and fatty acids which is absorbed and re-esterified to Tg.
III) Tg is coated with phospholipids and protein forming chylomicrons or very low density lipoproteins (VLDL).
IV) Both chylomicron and LDL come out of the cell and transported via lymphatics in to blood.

Protein :

Dietary protein is initially hydrolysed by gastric pepsin and pancreatic enzymes forming a mixture of peptides and amino acids and then absorbed.

Carbohydrate:

Diet consists of starch (60%) + lactose(10%) + sucrose(30%) and is digested to glucose, galactose and fructose and then absorbed.

GASTROINTESTINAL TRACT : Anatomy and physiology of gastrointestinal system

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Image:A

Image:B
Gastrointestinal tract showing gross anatomy (A) and structure (B).

Anatomy and physiology of Gastrointestinal System:

The gastrointestinal system is primarily involved in reducing food for absorption into the body.
This process occurs in 4 main phases:
i) Fragmentation
ii) Digestion
iii) Absorption
iv) Elimination of waste products

- Initial fragmentation of food occurs along with the secretions of the salivary glands, in the oral cavity forming a bolus.
- Bolus of food is then carried to the esophagus by the action of the tongue and pharynxc(deglutition).
- Esophagus carries food from mouth to stomach, where fragmentation is completed and digestion initiated.

- Digestion is the progressive breakdown of food by enzymes into molecules which are small enough to be absorbed into the circulation (Eg: protein to polypeptides followed by small peptides and amino-acids).
- In the stomach food is converted into semi-digested liquid (chyme) which passes through the pylorus, into the duodenum.
- Unabsorbed liquid residue enters the cecum through ileo-cecal valve where water is absorbed and become progressively more solid as it passes into the anus.
- Mucosal epithelium consists of three types of cells (Enterocyte ; Goblet and Paneth cells) and is replaced every 3-5 days by gradual maturation of basal enterocytes.

- Mucosa of Gastrointestinal tract consists of 4 basic types:
i) Protective - squamous type in the oral cavity, pharynx, esophagus and anal canal.
ii) Secretory - gastric mucosa consists of tubular glands
iii) Absorptive - intestinal mucosa consists of villi with intervening crypts.
iv) Absorptive and protective - mucosa lines the large intestine. This consists of tubular glands to absorb water and goblet cells to secrete mucus to lubricate the passage of faeces.

GASTROINTESTINAL TRACT : Contents

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DISEASES OF THE GASTROINTESTINAL TRACT

Anatomy and physiology of gastrointestinal system
Mechanisms of digestion : Fat metabolism ; Protein ; Carbohydrate
Drug related lesions of the Gastrointestinal Tract

ESOPHAGUS (Visit:Esophageal Pathology)
Anatomy and physiology
Normal Histology of Esophagus
An approach to the reporting of esophageal biopsies
Congenital Anomalies: Atresia and tracheoesophageal fistulas
Congenital Anomalies: Stenosis, webs, and rings
Achalasia
Hiatal Hernia
Diverticulum
Lacerations and Mallory-Weiss Syndrome
Esophagitis - Reflux esophagitis ; Infectious and Chemical esophagitis
Barrett's Esophagus
Barrett's Esophagus (Intestinal metaplasia, dysplasia and adenocarcinoma)
Varices
Benign Tumour
Benign tumours and tumour-like conditions of Esophagus
1. SQUAMOUS PAPILLOMA OF THE ESOPHAGUS
2. INFLAMMATORY FIBROID POLYP OF THE ESOPHAGUS
3. LEIOMYOMA OF THE ESOPHAGUS
4. GRANULAR CELL TUMOUR OF THE ESOPHAGUS
5. ESOPHAGEAL CYSTS
6. GLYCOGENIC ACANTHOSIS
7.FIBROVASCULAR POLYPS
Reporting of Esophageal Resection Specimens
Squamous Epithelial Dysplasia including Squamous Cell Carcinoma In-Situ of the Esophagus
Malignant Tumours
Esophageal Squamous Cell Carcinoma
Esophageal Adenocarcinoma
Carcinosarcoma of the Esophagus
Small Cell Carcinoma of the Esophagus

SALIVARY GLANDS : Acinic Cell Carcinoma

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Image: Acinic cell carcinoma - Shows clear basophilic cells arranged in groups with lymphocytic infiltration in stroma.

Acinic Cell Carcinoma:

- Acinic cell carcinoma constitutes about 5% of all carcinomas of salivary gland and are mostly seen in the parotid gland.
- They are sometimes bilateral and/or multicentric.
- It is seen in patients from early childhood to old age, the peak incidence being the fifth decade.
- Grossly, they are generally small, discrete and appear capsulated.
- Microscopic features :
i) Composed of cells with clear cytoplasm, sometimes vacuolated or solid type.

ii) The cells have characteristic basophilic cytoplasm and arranged in solid sheets or microcystic, glandular, follicular or papillary patterns.

iii) There is little anaplasia or few mitoses, but there may be slight pleomorphism.
iv) The stroma is usually infiltrated with lymphoid tissue.
- Prognosis:
i) Recurrence after resection is uncommon.

ii) About 10% to 15% tumours metastasize to lymphnodes.
iii) Survival rate is about 90% at 5 years.

SALIVARY GLANDS : Adenoid cystic carcinoma

2009-11-16T12:05:00.000-08:00

Image: Adenoid cystic carcinoma - Myoepithelial cells are arranged in cribriform pattern. A portion of normal parotid is on the left side.

Adenoid Cystic Carcinoma:

- Adenoid cystic carcinoma constitutes about 10% salivary gland tumours, particularly the minor salivary glands.
- Similar tumours have been reported in the nose, paranasal sinuses, lacrimal glands, ear canal,and tracheobronchial tree.
- Peak incidence is in the sixth decade.
- Grossly, they are small poorly encapsulated, infiltrative and gray-pink lesions.

- Microscopic features:
i) They are composed of small cells, having dark, compact nuclei and scant cytoplasm.
ii) These cells are arranged in tubular, solid, or cribriform patterns.
iii) Spaces between the tumour cells are often filled with hyaline material.
- About 50% or more disseminate widely to distant sites such as bone, liver and brain.
- Tumours of the minor salivary glands have a poor prognosis than those primary in the parotids.

SALIVARY GLANDS : Oncocytoma (Oxyphil adenoma)

2009-11-16T12:04:00.000-08:00

Image: Oncocytoma - Uniform plump oncocytes with granular eosinophilic cytoplasm arranged in glandular pattern.

Oncocytoma (Oxyphil adenoma):

- Oncocytoma is an uncommon solid, benign tumour (about 1% of parotid tumours).
- They are mostly seen in the parotid glands of elderly persons.
- Microscopic features:
i) The tumours are composed of uniform, plump cells with granular eosinophilic cytoplasm and centrally placed nucleus.
ii) The cells are arranged in sheets and glandular pattern with scanty stroma.
iii) Clear cell variety is also reported.