A clinicopathological study of basaloid squamous carcinoma of the esophagus

We reviewed the clinicopathological characteristics of 14 patients who underwent resection of basaloid squamous carcinoma (BSC) of the esophagus. The mean age was 65.3 years, and all patients were male. Seven patients had superficial BSCs and 7 had advanced BSCs. BSCs were associated with high rates of lymph node metastases and venous invasion. With regard to immunohistochemistry, the rate of cyclin D1 expression was higher (13/14), and the preservation rate of E-cadherin expression was lower (4/14), than that seen in ordinary esophageal squamous cell carcinoma. Squamous cell carcinoma components were most often found at sites of lymph node metastases, whereas basaloid components predominated at sites of hematogenous metastases in 4 patients, including lung, brain, and liver. Seven of the 9 patients with stage I or II disease are alive without recurrence. All patients with stage III or IV tumors developed recurrent disease. Primary tumors responded well in 3 patients who received preoperative chemotherapy (5-fluorouracil plus cisplatin) and/or radiotherapy, but further studies are needed to clarify the role of chemoradiotherapy. We believe that control of the hematogenous spread of basaloid components may lead to improved outcomes in patients with esophageal BSC.     

Clinicopathological features of superficial spreading and nonspreading squamous cell carcinoma of the esophagus

OBJECTIVES: Superficially spreading carcinoma of the esophagus, consisting mainly of intraepithelial carcinoma, is not as rare as was previously thought. Despite the surgical significance of this entity, no general definition has been established, and the clinical features of this disease remain to be clarified. METHODS: A total of 54 patients with superficial carcinoma of the esophagus (defined as carcinoma limited to the epithelium or superficially invading the lamina propria or submucosa) were classified into two groups according to the longitudinal extent of the lesion. A total of 13 patients with superficially spreading carcinoma (defined as a superficial carcinoma measuring >5 cm and consisting mainly of intraepithelial carcinoma) were compared to 41 patients with nonspreading esophageal carcinoma. RESULTS: One patient with superficially spreading carcinoma had a positive resection margin because of multiple cancerous lesions. The only significant difference in the clinical and pathological features of the two groups was a higher prevalence of associated multiple cancerous lesions in patients with the superficially spreading type. CONCLUSIONS: Superficially spreading carcinoma of the esophagus is often associated with multiple cancerous lesions. For endoscopists and esophageal surgeons, it is important to define the proximal extent of intraepithelial cancer and the presence of multiple cancerous lesions to perform curative resection.     

Multicenter retrospective analysis of clinicopathological features and prognosis of oral tongue squamous cell carcinoma in adolescent and young adult patients

The aim of this study is to report the differences in clinicopathological features of oral tongue squamous cell carcinoma (OTSCC) and survival between adolescent and young adult (AYA) patients and elderly patients and to find the prognosticators. The medical records of 101 AYA patients and 175 control patients with OTSCC who underwent surgery were reviewed. Variables related to prognosis and their clinicopathological associations were analyzed. The 5-year overall survival (5y-OS) rates of AYA and control patients with stage I and II OTSCC were 94.4% and 89.6% (P = .353), respectively, and their 5-year disease-free survival (5y-DFS) rates were 82.0% and 76.6%, respectively (P = .476). The 5y-OS rates of patients with stages III and IV OTSCC were 83.3% and 66.7% (P = .333), respectively, and their 5y-DFS rates were 75.0% and 57.1% (P = .335), respectively. Logistic regression analysis revealed that there was no significant clinicopathological difference in AYA and control group. Furthermore, there was no significant difference in 5y-OS rates between patients who underwent elective neck dissection (END) and those who underwent therapeutic neck dissection (TND) in both group (P = 0.717 and 0.688). Overall, the present study revealed the clinicopathological features and prognosis of OTSCC were similar in AYA patients and elderly patients. Moreover, as there was no significant difference in OS between patients who underwent END and those who underwent TND in AYA and control groups, our results suggest that the indication for END in AYA patients with clinical N0 OTSCC is similar to that for elderly patients.     

Basaloid squamous cell carcinoma of the esophagus

Purpose

Basaloid squamous cell carcinoma (BSCC) of the esophagus is a rare carcinoma with distinct characteristics. No standard treatment has been established. This retrospective study was designed to investigate the clinical and pathological characteristics, diagnosis, treatment, and prognosis of esophageal BSCC.

Methods

Clinical data were retrospectively analyzed from 26 patients with pathologically confirmed esophageal BSCC who underwent transthoracic esophagectomy with lymphadenectomy between January 1995 and June 2010 at the Cancer Hospital of Shantou University Medical College. Clinicopathologic data between BSCC patients and different histologic grades of esophageal squamous cell carcinoma (ESCC) patients were statistically compared by means of the χ² test or Fisher’s exact test. The Kaplan–Meier and log-rank methods were used to estimate and compare survival rates.

Results

Microscopically, BSCC was characterized by a nesting, lobular, or trabecular arrangement of small crowded cells with scant cytoplasm. None of the histologic specimens taken at preoperative esophagoscopy were diagnosed as BSCC. The median survival time (MST) of the 26 patients was 29.0?months (95% confidence interval, 9.0–49.0), and the 1-, 3-, and 5-year overall survival rates were 73.1, 42.7, and 36.6%, respectively. The MST for BSCC patients was significantly lower than that of well-differentiated SCC patients (P?=?0.024), but there were no significant differences between the MST for BSCC patients and that of moderately or poorly differentiated SCC patients (P?>?0.05).

Conclusions

BSCC of the esophagus is a rare but distinctive disease and is prone to be misdiagnosed by endoscopic biopsy. The prognosis is poorer than well-differentiated SCC, but similar to moderately or poorly differentiated SCC.     

Adipocytokines and squamous cell carcinoma of the esophagus

Purpose  

Adipocytokines are adipocyte-secreted hormones associated with some malignancies. It has been reported that the impaired response of adipocytokines to body weight loss may play a role in the pathogenesis of cancer-induced cachexia. We investigated the association between adipocytokines with squamous cell carcinoma of the esophagus (SCCE).     

Histological diversity in basaloid squamous cell carcinoma of the esophagus

Basaloid squamous cell carcinoma of the esophagus (BSCCE) is a distinct variant of esophageal cancer. This study investigated histopathological variations of BSCCE. Thirty-eight surgical and two endoscopically resected specimens of BSCCE were 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 using antibodies 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 were SCC. Immunoreactivity for CK7, CK14, and SMA was seen in 10.5, 86.8, and 18.4% of SN; 30.8, 97.4, and 38.5% of MT; 54.5, 100.0, and 54.5% of DD; 7.7, 76.9, and 23.1% 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 SMA immunoreactivity 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.     

Cyclooxygenase-2 expression in squamous cell carcinoma of the esophagus

Increased cyclooxygenase-2 expression has been reported to be a poor prognostic indicator in a number of cancers. In this study we investigated the relationship between COX-2 expression in squamous cell carcinoma of the esophagus and tumor characteristics and patient survival. The study group consisted of 90 men and 48 women who underwent esophagectomy for squamous cell carcinoma of the esophagus between October 1984 and May 1985. COX-2 expression was measured by immunohistochemistry in 138 primary cancers, 23 metastatic lymph nodes and 21 normal esophageal stumps. The relationship between the extent of staining for COX-2 and clinicopathological features and survival was determined. The extent of staining for COX-2 in both primary and metastatic cancers was higher than in normal squamous epithelia (P = 0.002 and P < 0.0001 respectively), and the grade of staining in the primary tumor correlated positively with the finding of lymph node metastases (P = 0.03). The 5-year survival rate in patients with less than 10% COX-2 positive cells was 47.5% compared to 23.2% in patients with more than 10% COX-2 positive cells (P = 0.0036). The relationship between survival and COX-2 staining was not due to COX-2 being a surrogate marker for TNM stage. Our results show that the expression of COX-2 is elevated in squamous cell carcinoma of the esophagus compared to normal epithelium and correlates with lymph node metastases. Survival was longer in those patients whose tumors expressed lower levels of COX-2.     

A case of synchronous squamous cell carcinoma in the esophagus and stomach

Synchronous esophageal and gastric cancers with the pathologic features of a squamous cell carcinoma are extremely rare. A 57-year-old male visited our hospital with a history of hematemesis and was diagnosed with a synchronous cancer. He underwent a staging work-up, and the resectable lesion in the stomach was operated on following radiologic and endoscopic evaluations. The pathologic examination revealed a synchronous cancer consisting of squamous cell carcinoma in the distal esophagus and the cardia of the stomach. We report a case of a synchronous cancer that was successfully treated by surgical resection followed by concurrent chemoradiotherapy. We also discuss the hypothesis regarding the origin and presentation of the synchronous cancer and highlight the importance of careful surveillance by physicians at the time of diagnosis.     

Nutritional assessment in patients with squamous cell carcinoma of the esophagus

BACKGROUND/AIMS: Protein-calorie malnutrition that occurs in patients with squamous cell carcinoma of the esophagus presents defined implications in surgical results. The present study aims to establish a nutritional score for malnutrition to measure the prevalence of protein-calorie malnutrition and to determine parameters with higher discriminatory power for protein-calorie malnutrition diagnosis. METHODOLOGY: Forty-five (45) patients with squamous cell carcinoma of the esophagus (cases) and 90 surgical patients (controls) were analyzed using twelve parameters: percentage of body weight loss, triceps and subscapular skin fold, mid arm circumference and arm muscle circumference, serum total proteins, albumin, transferin, pre-albumin, hematocrit, total lymphocyte count and late hypersensitivity skin tests. Prognostic Nutritional Index was calculated for all patients. RESULTS: There was a statistically significant difference between the two groups (p < 0.05) regarding all evaluated parameters except late hypersensitivity skin tests. Patients were classified as malnourished when presented with six or more altered parameters. Through the proposed score, the prevalence of protein-calorie malnutrition was defined in cases (57.8%) and in controls (7.8%) groups with statistic significant difference (p = 0.001). CONCLUSIONS: The proposed score allowed the diagnosis of malnourished patients, defined the malnutrition prevalence in both groups and established parameters with a greater discriminatory power for the protein-calorie malnutrition diagnosis.     

A case of verrucous squamous cell carcinoma of the esophagus

We report a rare case of verrucous squamous cell carcinoma (VSC) of the esophagus. A 73-year-old woman presented to our hospital with dysphagia. On gastrointestinal endoscopy, a white mass with a cauliflower-like appearance (3.5 cm in diameter) was detected in the upper esophagus at 23 cm from the incisors. Histological examination of a biopsy specimen revealed squamous epithelial hyperplasia and no malignancy. During 17 months of follow-up by repeated endoscopy, the lesion showed no marked changes in appearance. However, reexamination of the specimen obtained by partial endoscopic mucosal resection (EMR) using a jumbo biopsy forceps revealed very well differentiated squamous cell carcinoma corresponding to VSC. The clinical and histopathological characteristics of esophageal VSC are discussed on the basis of the published literature.     

Transhiatal esophagectomy for squamous cell carcinoma of the esophagus.

Eighty patients underwent transhiatal esophagectomy for squamous cell carcinoma of the esophagus. Dysphagia for solids was the presenting symptom in 90% of the patients. The standard technique of transhiatal esophagectomy was used and cervical anastomosis were hand sewn. The average operative time and blood loss were 190 min and 350 cc respectively. The 30 day mortality rate was 7.5% (six patients). Major respiratory complications were observed in 15 (18.7%) patients. Anastomotic leak rate was 10% (eight patients). The incidence of recurrent laryngeal nerve injury was 6.2% (five patients). The average hospital stay was 14 days. Four patients had stage I, 30 had stage II and 46 had stage III disease. Forty-nine patients (60%) had lymph node involvement. The overall actual survival at 2 years was 55% and at 5 years was 37%. Of the operative survivors, 87% patients resumed normal swallowing and 10 patients (13.5%) required dilatation for anastomotic stricture. Transhiatal esophagectomy can be performed with low operative mortality, acceptable morbidity and offers good long-term functional results without compromising the survival of patients.     

TESTIN和Caspase-3蛋白表达与食管鳞癌临床病理特征及预后的关系

目的 检测食管鳞癌中TESTIN基因和Caspase-3蛋白表达水平,及与食管鳞癌临床病理特征及预后的关系.方法 应用免疫组化法检测50例食管鳞癌及癌旁＞5 cm组织中的TESTIN蛋白和Caspase-3蛋白的表达水平.Western印迹及半定量RT-PCR法检测65例配对人食管鳞癌和癌旁组织中TESTIN表达的差异.分析两因素表达的相关性及其与食管鳞癌临床病理特征及预后的关系.结果 50例食管鳞癌标本中,免疫组化结果显示TESTIN蛋白和Caspase-3蛋白阳性率分别为30.0%(15/50)和24.0%(12/50),显著低于癌旁组织的84.0%(42/50)和94.0%(47/50),组间差异有统计学意义(P值均＜0.01).65例配对人食管鳞癌组织中,TESTIN mRNA的表达量显著低于癌旁组织(P＜0.05);Western印迹检测结果显示,69.2%(45/65)的食管鳞癌组织TESTIN蛋白表达量比对应癌旁组织下降(P＜0.01).TESTIN的表达与食管鳞癌分化程度有关,而与性别、年龄、肿瘤大小、TNM分期、淋巴结转移无关.食管鳞癌中TESTIN在蛋白水平与Caspase-3表达呈正相关.TESTIN蛋白阴性表达者的累计生存时间显著低于阳性者(P＜0.05).结论 TESTIN和Caspase-3在食管鳞癌组织中的表达下调且呈正相关性,两者在食管鳞癌的发生发展过程中可能起协同作用,TESTIN对评价食管鳞癌的预后可能有较好价值.     

Screening the at-risk population for squamous cell carcinoma of the esophagus

Together with adenocarcinoma, epidermoid esophageal carcinoma is the most clinically important neoplasm of the esophagus. Because of the low incidence of epidermoid esophageal carcinoma in the general population, strategies for its early diagnosis are not a priority compared with other neoplasms. However, because survival is low when the disease is diagnosed in symptomatic patients (less than 20% at 5 years), methods for its early diagnosis should be investigated. The use of cytology or Lugol chromoendoscopy in countries with a high incidence of epidermoid carcinoma or in individuals at increased risk (mainly alcoholics and smokers) has allowed early diagnosis and potentially curative treatment, substantially increasing life expectancy in this group of patients. These results should stimulate the evaluation and eventual implementation of programs to achieve early diagnosis and therefore greater survival in patients with epidermoid esophageal carcinoma in Western countries.