Carcinomas in the Distal Esophagus of Chinese Patients Are Heterogeneous in Histopathology but Adenocarcinoma Remains Rare
Qin Huang, Gregory Y Lauwers, Jiong Shi, Qi Sun, Xaingshan Fan, Anning Feng, Hongyan Wu, Chenggong Yu, Qiang Zhou, Hiroshi Mashimo. Nanjing Drum Tower Hospital, Nanjing, China; VA Boston Healthcare System, West Roxbury; Massachusetts General Hospital, Boston
Background: Columnar-lined esophagus (CLE) is a premalignant lesion to esophageal adenocarcinoma (EAC) in Caucasian patients. In our recent study, CLE was found in 68% of Chinese patients with cancer in the gastroesophageal junction (GEJ). This finding is to date of unknown clinical significance in Chinese. Herein, we systematically investigated the histopathology of distal esophageal neoplasms and CLE in resection specimens from a high-volume medical center in China.
Design: A computerized search of esophageal cancer resection was conducted in the pathology database over a 7-year period from 2004 to 2010 at Nanjing Drum Tower Hospital in China. Cancers with epicenters located within 5 cm above the GEJ were retained for analysis. Pathology reports were reviewed along with medical, radiologic, and endoscopic records. Cases with neoadjuvant therapy were excluded. All histology slides of qualified cases were evaluated (13/case). In addition to conventional EAC and squamous cell carcinoma (SCC), major esophageal cancers, ie, basaloid SCC (B-SCC), adenosquamous, mucoepidermoid, and neuroendocrine carcinomas were identified, according to the World Health Organization classification of esophageal cancers. In cases with residual esophageal squamous mucosa, CLE and other pathologic changes were investigated. GEJ was defined grossly as the proximal end of gastric longitudinal mucosal folds and microscopically as the distal end of squamous epithelium, deep esophageal glands and ducts, and multilayered epithelium.
Results: Among 1,105 consecutive resection cases of distal esophageal cancers, 204 (19%) were qualified for the study. The patient median age was 62 years (range: 38-91). The male/female ratio was 8.0. EAC, SCC, B-SCC, adenosquamous, mucoepidermoid, and neuroendocrine carcinomas represented 1%, 76%, 12%, 3%, 2%, and 6% of the cases, respectively. Synchronous cancers were found in 12% of the cases with SCC (50%), neuroendocrine carcinoma (8%), and leiomyosarcoma (4%) in the distal esophagus and proximal gastric adenocarcinoma (38%). CLE was detected in 16%, among which intestinal metaplasia was found in 30% of the cases and low-grade dysplasia in 7%.
Conclusions: In the distal esophagus of Chinese patients in China, SCC and B-SCC remain predominant (88%), but EAC is rare (1%). CLE appears insignificant for most distal esophageal cancers in this patient population. Further investigation of CLE in the general Chinese population is on-going.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 58, Tuesday Afternoon