Semiquantitative Histologic Evaluation Improves Diagnosis of Esophageal Carcinoma Cuniculatum on Biopsy
Derrick Chen, John Goldblum, Michael Landau, Rish Pai, Shu-Yuan Xiao, Xiuli Liu. Cleveland Clinic, Cleveland, OH; University of Chicago, Chicago, IL
Background: Carcinoma cuniculatum (CC), a unique variant of well-differentiated squamous cell carcinoma, has been only rarely reported in the esophagus. Preoperative diagnosis of this entity is extremely difficult, particularly in small biopsies. This study was performed to determine if a previously observed common histologic pattern for CC is diagnostically useful in esophageal mucosal biopsy specimens.
Design: Thirty-five esophageal mucosal biopsies from 25 procedures in 11 patients with resection-proven CC were compared to 92 esophageal biopsies from 69 patients with benign diagnoses (control). All biopsies were assessed for the presence of hyperkeratosis, acanthosis, dyskeratosis, abnormal keratinization, intraepithelial neutrophils (IEN), neutrophilic microabscesses (NM), cytologic atypia, koilocyte-like cells, and keratin-filled cysts/burrows. Each feature, if present, was given 1 point, and the final histologic score was calculated for each biopsy by summing the points.
Results: The frequencies of each feature in the resections and mucosal biopsies from CC were significantly higher than those in esophageal mucosal biopsies from patients with benign diseases (Figures 1A&B). Mean histologic score was 6.66 (SD 1.88) in biopsies from CC vs. a mean score of 1.93 (SD 1.75) for biopsies with benign diagnoses (p<0.0001). Using a cut-off value of 7 for CC, 57.1% of biopsies (20/35) from 64% esophagogastroduodenoscopy procedures (16/25) in 90.9% patients (10/11) would be diagnostic, in comparison to the initial diagnostic rates for carcinoma of 8.6%, 12%, and 27.2%, respectively (p<0.0001 for all). None of the 92 benign biopsies showed a score of ≥7.
Conclusions: A semiquantitative histologic evaluation of mucosal biopsies taken from an esophageal mass greatly improves the diagnostic sensitivity for CC, with 100% specificity. Larger studies are necessary to confirm these findings.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 91, Monday Morning