Gastric Foveolar Type Dysplasia Is Common Adjacent to Esophageal Invasive Adenocarcinoma
IS Brown, DC Whiteman, GY Lauwers. Sullivan Nicolaides Pathology, Brisbane, Australia; Queensland Institute of Medical Research, Brisbane, Australia; Massachusetts General Hospital, Boston, MA
Background: Adenocarcinoma in the distal esophagus results of a metaplasia - dysplasia carcinoma sequence. While Barrett esophagus is an admixture of gastric and intestinal type epithelium, it is long held that only the intestinal phenotype is at risk for neoplastic transformation. The aim of this study was to examine the imunophenotype of dysplasia in the tubular esophagus adjacent to invasive adenocarcinoma.
Design: Sixty six (66) consecutive esophagogastrectomies for lower esophageal adenocarcinoma (N=9) or adenocarcinoma crossing the gastroesophageal junction (N=57) entered into the Australian esophageal cancer study from 6/2001 - 12/2006 were reviewed. The presence of background dysplasia in the tubular esophagus in continuity with the invasive tumour,overlying submucosal glands was recorded. Dysplasia was categorised morphologically into 3 patterns. 1) Gastric foveolar type (FT) characterised by cuboidal to columnar cells with pale clear cytoplasm and hyperchromatic round to oval nuclei, 2) Adenomatous type (AT) - composed of columnar cells with hyperchromatic penicillate pseudostratified nuclei and dense eosinophilic cytoplasm and 3) Mixed type (MT) showing cytological features intermediate between these two patterns or an admixture (>10%) of the two patterns. Immunohistochemical reactions for p53, Ki 67, gastric foveolar differentiation (MUC5AC) and intestinal differentiation (MUC2, CDX2 and Villin) were evaluated in each case with dysplasia.
Results: Dysplasia (ranging from 0.5mm to >50mm in extent) was identified in 36 of the 66 specimens. FT dysplasia was seen in 19 (53%), AT dysplasia in 10 (28%) and MT dysplasia in 7 (19%) cases. MUC5AC was frequently positive in FT (P=0.07) but MUC2, Villin and CDX2 were negative (all P<0.005). By contrast, AT was frequently positive for MUC2, Villin and CDX2 (all P<0.005).but less frequently positive for MUC5AC (P=0.20).
Table of Immunohistochemistry results % positive
Conclusions: Dysplasia in the lower esophagus associated with invasive adenocarcinoma often displays morphologic and immunophenotypic features of gastric foveolar differentiation. There is good concordance between morphologic classification and immunohistochemical phenotyping of the dysplasia patterns.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 104, Tuesday Afternoon