Esophageal carcinoma cuniculatum: systematic review of the literature and report of two cases

Background and AimsCarcinoma cuniculatum (CC) is a rare variant of an extremely well-differentiated squamous cell carcinoma. The most commonly involved site is the skin, with a preference for the sole. Only 15 cases of esophageal CC have been reported so far. Based on published data, the clinical behavior of CC has not been clearly defined. We describe the clinical-pathologic features of two cases of esophageal CC, and provide a review of the available literature, to shed more light on this unusual tumor.MethodsA detailed gross and histologic analysis was performed on two cases of surgically treated esophageal CC. The patients were followed-up after surgery. A systematic search was also done concerning studies focused on esophageal CC. A search of the electronic databases MEDLINE-PubMed was conducted using the following research terms: (esophagus) AND (cuniculatum carcinoma).ResultsBoth patients were alive at last follow-up at six and nine months from surgery without any recurrence. Concerning the fifteen cases reported from the systematic review, median follow-up after surgery was very long as compared to common esophageal cancers (4.0 years), with only one recurrence observed.ConclusionCC shows an indolent clinical behavior, with a low recurrence rate after radical surgery. The diagnosis of this rare tumor is typically made after surgery. An aggressive approach is required with curative intents.     

食管癌中COX-2表达与其临床病理特征及预后的关系

目的：检测COX-2在食管癌中的表达，探讨其与食管癌临床病理特征及术后患者预后的关系。方法：应用SABC免疫组化染色法检测89例手术切除的食管癌组织和20例正常食管粘膜组织COX-2蛋白的表达，分析COX-2在食管癌组织的表达与患者性别、年龄、肿瘤部位、病变长度、浸润深度、区域淋巴结转移、远处转移、鳞癌分化程度的关系。并对其中81例有随访资料者，分析COX-2表达与预后的关系。结果：食管癌组COX-2呈阳性表达率为94.38%（84/89），且着色较深，正常食管组COX-2呈阳性表达率为60%（12/20），着色浅。食管癌中，随着肿瘤浸润深度的增加、鳞癌细胞分化程度的减低，COX-2的表达逐步增强（P＜0.05）。COX-2的表达与其它临床病理特征，包括性别、年龄、肿瘤生长部位、肿瘤大小、有无区域淋巴结转移、有无远处转移无相关（P＞0.05）。COX-2低表达组与高表达组的生存时间有显著差异，前者生存时间较后者为长（P＜0.01）。结论：COX-2在食管癌中的表达高于正常食管粘膜。肿瘤浸润越深、鳞癌分化程度越低，COX-2的表达越强；COX-2的表达与食管癌患者的年龄、性别、肿瘤生长部位、肿瘤长度、有无区域淋巴结转移、有无远处转移均无关。COX-2的表达与食管癌术后患者的预后相关，COX-2呈低表达者的生存时间比COX-2高表达者长。     

Prevalence and prognostic significance of neuroendocrine cells in esophageal adenocarcinoma.

Neuroendocrine differentiation is common in adenocarcinomas of the stomach and colon and may be associated with a slightly better prognosis in gastric adenocarcinoma. We studied neuroendocrine differentiation in esophageal adenocarcinomas and associated Barrett's esophagus (BE) to determine association with patient outcome. Fifty-eight cases of esophageal adenocarcinoma (15 biopsies, 43 resections) from 52 patients were stained with a monoclonal antibody to chromogranin (CG). Medical records were reviewed for tumor stage, response to therapy, and patient survival. Thirty-two patients received radiation and chemotherapy, and four received radiation. Twelve of 58 (20.7%) esophageal adenocarcinomas contained scattered CG-positive cells. Tumors with CG-positive cells were moderately to poorly differentiated, and many consisted of large cribriform glands, similar to intestinal-type adenocarcinomas. One case of small cell carcinoma of the esophagus was weakly CG positive; another was negative. Neuroendocrine differentiation was retained in lymph node metastases in two cases but lost in three other cases. In 10 CG-negative primary tumors, lymph node metastases were also negative. For five of six patients with paired biopsy/resection specimens, no CG-positive cells were seen in either specimen; one patient had CG-positive cells only in the resection. There was no difference in tumor stage at surgery or survival time between CG-positive and CG-negative tumors. BE was present in 34 cases and contained CG-positive cells in 21 of 34 (61.8%). Low-grade dysplasia contained CG-positive cells in 11 of 14 cases (78.6%) and high-grade dysplasia in 3 of 6 cases. Fourteen of 21 (66.7%) adenocarcinomas associated with CG-positive BE were negative for CG. In summary, neuroendocrine differentiation is common in BE and is retained in low- and high-grade dysplasia but is usually lost in esophageal adenocarcinoma. The presence of scattered neuroendocrine cells does not affect patient outcome.     

环氧化酶2在反流性食管炎和食管癌中的表达

目的 检测环氧化酶2(COX-2)在反流性食管炎和食管癌中的表达,探讨其与临床病理的关系.方法 应用免疫组化染色法检测并以计分法判定35例反流性食管炎胃镜活检组织、89例手术切除的食管癌组织和20例正常食管黏膜组织COX-2的表达.分析反流性食管炎中COX-2的表达与年龄、性别、不典型增生的程度和内镜下分级等临床病理的关系.分析食管癌中COX-2的表达与肿瘤部位、病变长度、浸润深度、区域淋巴结转移、远处转移、鳞癌分化程度等临床病理参数的关系.结果 COX-2在正常食管黏膜、反流性食管炎、食管癌中的表达率分别为60.00%、88.57%、94.38%,且食管癌组着色最强、正常食管组着色最弱.反流性食管炎中,COX-2的表达与不典型增生呈正相关(r,=0.490,P<0.01);食管癌中,COX-2的表达与肿瘤浸润深度呈正相关(rs=0.215,P<0.05),与鳞癌细胞分化程度呈负相关(rs=-0.427,P<0.01).COX-2的表达与其它临床病理参数,包括性别、年龄、反流性食管炎内镜下分级、食管癌生长部位、大小、区域淋巴结转移、远处转移无关.结论 COX-2在正常食管黏膜、反流性食管炎、食管癌组织中的表达呈逐级上调的趋势.反流性食管炎不典型增生越严重,COX-2的表达越强;食管癌肿瘤浸润越深、鳞癌分化程度越低,COX-2的表达越强.     

Paraneoplastic vasculitis associated with esophageal carcinoma

We report a case of esophageal carcinoma associated with paraneoplastic vasculitis. A 69-year-old man suffered from low-grade fever and numbness of the lower limbs for 3 months before esophageal and gastric carcinomas were detected. Concurrent infection or collagen disease was ruled out following clinical and laboratory examinations. In April 1996, the gastric carcinoma was completely removed by endoscopic mucosal resection, but the symptoms remained. Three weeks later esophagectomy was performed for esophageal carcinoma after which time the fever and numbness disappeared. The esophageal carcinoma was a well-differentiated squamous cell carcinoma invading into the submucosal layer. Twenty-two lymph node metastases were found in 68 resected lymph nodes. Latent thyroid cancer was found. Histologically, vasculitis was detected in the esophagus, stomach and serratus anterior muscle. The distribution and degree of vasculitis were most pronounced in the esophagus. The concurrent onset and spontaneous resolution of fever and numbness after the removal of the esophageal carcinoma suggested a paraneoplastic origin. The majority of patients with malignant neoplasm-associated vasculitis had hematologic neoplasms. Cases of esophageal carcinoma associated with paraneoplastic vasculitis are extremely rare.     

New pathologic entities in penile carcinomas: an update of the 2004 world health organization classification

Most primary malignant tumors of the penis are squamous cell carcinomas (SCC) of the usual type. In recent years several variants, each with distinctive clinicopathologic features, have been described. Pseudohyperplastic carcinoma and carcinoma cuniculatum are both low-grade, extremely well-differentiated SCC variants characterized by an indolent clinical course and good prognosis. The former, which may be confused with pseudoepitheliomatous hyperplasia, preferentially affects the inner foreskin mucosa of elderly men and the latter is a verruciform tumor with an endophytic, burrow-like pattern of growth. Pseudoglandular carcinoma (featuring solid tumor nests with extensive central acantholysis simulating glandular lumina) and clear cell carcinoma (human papillomavirus [HPV]-related tumors composed of periodic acid-Schiff positive clear cells) are aggressive tumors with a high incidence of inguinal nodal metastases. Papillary carcinomas are HPV-unrelated verruciform tumors composed of complex papillae with acanthosis, hyper- and parakeratosis, absence of koilocytes, irregular fibrovascular cores, and jagged tumor base. Finally, in warty-basaloid carcinomas areas of warty (condylomatous) and basaloid carcinomas coexist in the same tumor, either separated or intermingled, giving the tumor a variegated appearance. In this review special emphasis is given to the differential diagnosis of these special variants with a discussion of the possible implications for clinical management.     

P-glycoprotein expression in gastroesophageal adenocarcinomas, their metastases, and surrounding mucosa: a mapping study.

Previously, we identified P-glycoprotein in primary gastroesophageal adenocarcinomas and in adjacent mucosa. This study is a further investigation of P-glycoprotein expression in adenocarcinomas and benign mucosa. Sixteen resection specimens were studied (seven for gastric adenocarcinoma, seven for esophageal adenocarcinoma, one for adenocarcinoma at the gastroesophageal junction, and one for severe dysplasia in Barrett's esophagus). Multiple samples of tumor and mucosa were submitted according to a specimen diagram. Lymph node and distant metastases were studied when available. P-glycoprotein expression was identified in paraffin-embedded tissues by immunohistochemistry using monoclonal antibody C219 and was scored as the percentage of cells stained. P-glycoprotein was identified in six of 16 resection specimens. Intratumoral variability of C219 score was noted in three resections. No increase in expression was identified in lymph node or distant metastases as compared with primary tumors or in the invasive margin of the tumor as compared to the center. For every case in which tumors expressed P-glycoprotein, it was also diffusely present in all types of benign gastric and Barrett's mucosa, both adjacent to and distant from (up to 8 cm) the tumor. We also studied biopsies from 10 patients with Barrett's esophagus who did not have carcinoma. P-glycoprotein was only focally present in one of the 10 biopsies. Mucosa expressing P-glycoproteins may be the substrate from which a P-glycoprotein positive tumor arises.     

p14ARF, a prognostic predictor in HPV-negative vulvar carcinoma

The present study addressed the impact of human papillomavirus (HPV), p14, and the product of the retinoblastoma gene (pRb) in vulvar carcinoma in relation to other clinicopathologic variables and prognosis. We immunohistochemically studied 217 primary tumors from patients with vulvar carcinoma for the expression of pRb and p14. By the use of in situ hybridization, the primary tumors and 7 lymph node metastases were studied for the presence of HPV-16, HPV-18, HPV-31, and HPV-33 DNA. HPV-infected cases significantly correlated with high expression of p14 (P < .01) and p16 (P < .01). In HPV- cases with high expression of p53, no p14 expression predicted the poorest disease-specific survival (P < .01). For the first time, we have shown that p14 expression indicates longer disease-specific survival in patients with vulvar carcinoma. In patients with HPV- tumors expressing high levels of p53, low p14 indicated the poorest 5-year disease-specific survival.     

MDM2 and CDK4 expression in carcinosarcoma of the esophagus: comparison with squamous cell carcinoma and review of the literature

Certain tumors of the esophagus that display both sarcomatous and carcinomatous features have long been recognized. The nomenclature, classification, and histogenesis remain controversial and the microscopic differential diagnosis from other esophageal malignancies can be challenging, particularly in small biopsies. In this paper, we review the literature of carcinosarcoma and present two cases of esophageal carcinosarcoma, describing their salient histologic, immunohistochemical, and ultrastructural features. Also, we assess the expression of MDM2 and CDK4 in the carcinomatous and sarcomatous compartments of our cases and we compare them with the expression of these oncogenes in selected cases of esophageal squamous cell carcinoma with prominent stromal reaction. In both of our cases, identification of some epithelial ultrastructural and immunohistochemical features in cells of otherwise sarcomatous phenotype lends support to the common epithelial origin of these neoplasms. Moreover, positive staining for MDM2 and CDK4 in our cases with equally strong reactions in both carcinomatous and sarcomatous elements provides evidence of a role for these molecules in the pathogenesis of carcinosarcoma. In contrast, in cases of squamous cell carcinoma with prominent stromal reaction only the epithelial cells stained strongly for MDM2 and CDK4. These differences in the MDM2 and CDK4 immunohistochemical profile between carcinosarcomas and carcinomas of the esophagus may assist in their differential diagnosis.     

Granular-cell tumor of the esophagus: Report of a case with a cytologic diagnosis based on esophageal brushing

We report a case of granular-cell tumor (GCT) in the esophagus. This is a rare location for this tumor and only 80 cases have been described. The tumor was diagnosed in a 24-yr-old woman with epigastralgia. Endoscopic examination revealed a submucosal ulcerated lesion. The smears derived from esophageal brushings contained clusters of granular cells. Histologic examination of the endoscopic biopsy provided diagnostic confirmation of GCT. To our knowledge, this is the first reported case of esophageal GCT in which the characteristic tumor cells were seen in the endoscopic brushing material. This case demonstrates that a cytologic diagnosis of GCT is possible if the lesion is ulcerated and/or brushing is subsequent to taking the biopsy. Although rare in the esophagus, GCT should be considered in the differential diagnosis of esophageal neoplasms. Diagn. Cytopathol. 1998;19:455–457. © 1998 Wiley-Liss, Inc.     

An extensive morphological and comparative study of clinically early and obvious squamous cell carcinoma of the esophagus

Squamous cell carcinoma of the esophagus appears mainly as an isolated tumor, frequently diagnosed in its latest stage. However, current advances in endoscopy, systematically used for high risk subjects, allow the detection of very early lesions such as epithelial dysplasia or in situ carcinoma. Twenty-eight squamous cell carcinomas were extensively studied: Group A contained 15 clinically "early cancers"; Group B 12 clinically obvious carcinomas and group C one clinically obvious bifocal carcinoma. All 15 "early cancers" were multicentric and composed of large fields of invasive, microinvasive or in situ carcinoma around which were found epithelial dysplasias of various degrees. Lymph node metastases at surgery were found in 26% of these cases. Obvious squamous cell carcinomas were contiguous with dysplastic areas in 16.6% and with in situ carcinomas in 33% of these cases. Half (50%) had lymph node metastases at surgery. There was no dysplasia or in situ carcinoma around the two main tumors of group C. A comparison between the different morphological features of the three groups leads us to question whether the solitary tumor of the esophagus really represents the final evolution of an early multifocal carcinoma.     

Collision metastasis of prostatic and colonic adenocarcinoma: report of 2 cases

Collision metastases of carcinomas in lymph nodes are rare. Carcinoma metastasizing to lymph nodes containing malignant lymphoma has also been reported. The literature contains 3 cases of collision metastasis of prostatic and urothelial carcinoma. To our knowledge, we report the first 2 cases of collision metastasis of prostatic and colonic adenocarcinoma, one involving a mesenteric lymph node and the other involving a perirectal lymph node, both from resections for colonic adenocarcinoma in patients with known metastatic prostatic carcinoma.     

Parameters predicting lymph node metastasis in patients with superficial esophageal squamous cell carcinoma

Endoscopic resection is a less invasive treatment than esophagectomy for superficial esophageal squamous cell carcinoma, but patients with lymph node metastasis need additional treatment after endoscopic resection. The purpose of this study was to establish a set of indicators to identify superficial esophageal squamous cell carcinoma patients at a high risk of metastasis. In all, 271 superficial esophageal squamous cell carcinoma esophagectomy cases were reviewed retrospectively. The relationships between clinicopathological parameters and immunohistochemical findings (p53, cyclin D1, EGFR and VEGF) on tissue microarrays, on the one hand, and lymph node metastasis were assessed by univariate and multivariate logistic regression analyses. Patients with intraluminal masses and ulcerated masses had a high risk of lymph node metastasis. Patients with superficial esophageal squamous cell carcinoma (1) thinner than 1200?μm; (2) confined to the mucosa; (3) with submucosal invasion <250?μm; (4) with submucosal invasion ≥250?μm but with negative VEGF expression and well/moderately differentiated or basaloid histology; or (5) with submucosal invasion ≥250?μm but with weak VEGF expression and well-differentiated histology had almost no risk of lymph node metastasis. We recommend endoscopic resection for all erosive, papillary and plaque-like superficial esophageal squamous cell carcinomas where endoscopic resection is clinically feasible, and esophagectomy for all other erosive, papillary and plaque-like cases and all intraluminal masses and ulcerated tumors. No additional treatment is needed for endoscopic resection cases with superficial esophageal squamous cell carcinoma (1) thinner than 1200?μm; (2) confined to the mucosa; (3) with submucosal invasion <250?μm; (4) with submucosal invasion ≥250?μm but with negative VEGF expression and well/moderately differentiated or basaloid histology; or (5) with submucosal invasion ≥250?μm but with weak VEGF expression and well-differentiated histology. These clinical and pathological criteria should enable more accurate selection of patients for these procedures.     

Human papillomavirus (HPV) DNA in penile carcinomas in Argentina: analysis of primary tumors and lymph nodes

Among sexually transmitted diseases, infection by human papillomavirus (HPV) has become one of the most important. On the other hand, though epidemiological data show that some HPV types are closely associated with cervical cancer, few reports have been found with reference to penile carcinoma because of its rare occurrence. The aim of this study was to investigate the relationship between HPV infection and penile cancer in Argentina. A retrospective study was carried out on 38 white men with penile squamous-cell carcinoma. Sixty-five archival fixed biopsies taken from 34 primary penile tumors, 25 nodal metastases, 1 skin "satellite" metastasis and 5 histologically normal lymph nodes were used as specimens. HPV detection and typing were carried out by the polymerase chain reaction (PCR) using generic primers, combined with single-stranded conformational polymorphism (SSCP) analysis. HPV DNA was found in 71% patients, corresponding 81% of them to "high risk" types, with predominance of HPV 18. Both primary tumors and metastases showed concordance of HPV occurrence and type in both lesions. In 3 patients, HPV 16 was detected not only in primary tumors and metastases, but also in histologically normal lymph nodes. Our data indicate that most penile carcinomas in Argentine patients are etiologically related to HPV, especially to "high risk" genital types. The agreement in HPV detection between primary tumors and metastases suggests a potential viral role in tumor progression. HPV detection in otherwise histologically normal lymph nodes might be useful as early marker of a metastatic process.     

Use of cellulose acetate millipore filters for the correct orientation of endoscopic biopsies in digestive diseases

INTRODUCTION: Properly oriented endoscopic biopsies allow an effective assessment of some diagnostic features in non neoplastic gastrointestinal diseases. MATERIALS AND METHODS: We used cellulose acetate millipore filters (Endofilter, Bio-Optica, Milan, Italy) in order to improve the orientation of biopsies during processing. Forty biopsies were placed on filter after endoscopic sampling whereas no orientation attempt was done for other 40 filter-free biopsies (20 from esophagus and 20 from gastric antrum in each group). Both groups were compared in terms of orientation and assessability of the following morphological features: thickness of basal layer in the esophageal squamous epithelium, length of esophageal papillae, interstitial space dilatations in the esophageal squamous epithelium and gland atrophy in the gastric antrum. Both orientation and assessability of individual morphological features were graded with a score ranging from 1 (good) to 3 (poor). The impact of this procedure on costs was analysed, both in terms of material and technical workload. RESULTS: All 20 esophageal and 20 antral biopsies on filter showed acceptable (score 1 or 2) orientation. In contrast, 14/20 filter-free esophageal and 13/20 antral biopsies showed poor (score 3) orientation (p = 0.0001 for both groups). Basal layer thickness was assessable (score 1 or 2) in 20/20 esophageal biopsies on filter vs 14/20 filter-free ones (p = 0.0001) and length of papillae in 15/20 biopsies on filter vs 4/20 filter-free ones (p = 0.0002). Interstitial space dilatation assessability was not affected by orientation procedures. Gland atrophy in the antrum was assessable (score 1 or 2) in 20/20 gastric biopsies on filter vs 8/20 filter-free ones (p = 0.0001). The use of endofilters permitted the process of numerous (up to 8 for each block) samples from different biopsy sites together and produced a significant reduction in costs (18.35 in the case of 8 biopsies from 4 different biopsy sites). CONCLUSIONS: The use of millipore filters allows orientation of biopsy samples, improves the assessment of several diagnostic features in esophageal and gastric pathology and yields a significant reduction in costs when biopsies from different sites are processed together.     

Cancer of the esophagus: histopathological sub-types in northern Uganda

Background

Esophageal cancer is the eighth most common cause of cancer death worldwide with squamous cell carcinoma and adenocarcinoma carcinoma as the main histopathological subtypes. Esophageal cancer is known for its marked variation by geographic region, ethnicity, and gender. Hitherto, the histopathological subtype of this cancer in Northern Uganda were not known. Therefore the aim of the study was to describe the characteristics of esophageal cancer with respect to the histopathologic subtypes, different sites of occurrence, age and gender in this region since its distribution varies with location.

Methods

The study was carried out at Lacor Hospital, in northern part of Uganda. The record of 71 patients who had endoscopic and histopathological diagnosis of cancer of esophagus over a period of 3 years between January 2009 and December 2011 were retrospectively analyzed.

Results

A total of 140 patients had endoscopic diagnosis of cancer of the esophagus and of these, 71 patients had both endoscopic and histopathological diagnosis of cancer of esophagus during the three-year period covered in the study between January 2009 to December 2011. The female to male ratio was 1:3 with mean age of 55.5 years ± SD 11.8. The common histopathological pattern of cancer of esophagus was squamous cell carcinoma of esophageal consisting of 66 patients (93.o%). The ratio of squamous cell carcinoma to adenocarcinoma was 13:1.The majority of the esophageal cancers were found in the middle third with 38 patients (53.52%), followed by lower third with 27 patients (38.0%) and the upper third which was only 6 patients (8.5%).

Conclussions

Squamous cell carcinoma is the most common histopathological subtype in this geographical location with overall cancer of the esophagus mainly affecting the lower 2/3 of the esophagus with the majority in the middle third.     

Rare variants of head and neck squamous cell carcinoma –differential immunohistochemical profiles

We aimed to immunohistochemically characterize the pattern of expression of epithelial markers in rare head and neck squamous cell carcinoma (HNSCC) variants: carcinoma cuniculatum (CC) and adenosquamous carcinoma (ASC). We also present an additional variant of HNSCC with concomitant basaloid and squamous components that has overlapping morphological features with odontogenic and non-odontogenic tumors, which we termed basalo-squamous carcinoma (BSC). The selected markers included CK5/6, p40, CK19, BerEP4, p16 and SOX10. All tumors were CK5/6 and p40 positive. CK19 and BerEP4 were positive in BSC and focally in ASC but negative in CC. p16 was positive in 3 (60%) of the CCs, focally positive in ASC and negative in BSC. SOX10 was negative in all three variants. Our results highlight the plasticity of the lining epithelium revealing differential profiles of immuno-expression of the selected molecular markers, possibly reflecting their diverse histopathogenesis.     

Carcinoma of the esophagus. An autopsy study of 231 cases

Autopsy findings for 231 cases of carcinoma of the esophagus are presented. Cases with tumour resection constituted 57% of the series. Residual malignancy was present in 81% of all cases. Local residual or recurrent tumour was found in 53%, lymph node metastases in 65% and visceral metastases in 54% of cases. Intrathoracic lymph node metastases were present in 41% of patients after tumour resection and were probably significant in the failure of radical surgery. Adequate clearance of intrathoracic lymph nodes during radical surgery may reduce the incidence of tumour recurrence in this group of patients. Survival was poor in patients with or without resection of the primary tumour. Less than 12% were alive 1 yr after presentation. The average duration of dysphagia at presentation was 2.5 mth. The poor survival of our patients suggests that, by the time they presented clinically, the disease was already advanced. Early disease detection is important for a chance of cure in patients with esophageal cancer.     

Role of brush cytology in the diagnosis of Barrett's esophagus: an analysis of eight cases

Although debatable, role of cytology in diagnosing Barrett's esophagus has been stressed by some authors. Our brief report analyses the role of brush cytology (BC) in its diagnosis. Eight patients who presented with upper gastrointestinal (GI) manifestations and subsequently diagnosed to have Barrett's esophagus with or without adenocarcinoma on brush cytology (BC) or, endoscopic biopsy (EB) or, a combination of both the techniques were included in the study. In all the cases routine cytologic smears and histologic sections with relevant special stains (when essential) were studied. On cytology, the diagnosis of "Barrett's esophagus" was made when the esophageal brushings obtained from a region beyond 3 cm from the gastroesophageal junction showed closely intermingled clusters of squamous and columnar cells, or when there was evidence of intestinal metaplasia. Adenocarcinoma in Barrett's esophagus was diagnosed by the usual criteria for malignancy with features of adenocarcinoma. Cytologic diagnoses were correlated with the histologic diagnoses. Of the eight cases, seven had histopathologic correlation of which six had evidence of BE on BC; four had cytohistologic concordance, of which three cases revealed adenocarcinoma arising in BE. Two endoscopic biopsies were nonrepresentative. In one case, cytology missed Barrett's esophagus. For two cases in which cytology detected Barrett's mucosa, biopsies were nonrepresentative. Our study showed brush cytology (BC) to be a fairly reliable test for detecting Barrett's esophagus. Owing to its inherent advantage of sampling a wider and circumferential area, a technically well performed brushing procedure is likely to be more representative and superior than multiple endoscopic biopsies.     

Isolated tumor cells in the regional lymph nodes in patients with squamous cell carcinoma of the esophagus are rarely observed but often represent part of a true metastasis

The most common malignancy of the esophagus is squamous cell carcinoma (SCC) and regional lymph node metastases are an important prognostic factor. Isolated tumor cells (ITCs) are defined as single tumor cells or small clusters of tumor cells not exceeding 0.2 mm. The prognostic role of ITCs is not clear. This study aimed to determine the prevalence of ITCs in regional lymph nodes in patients with esophageal SCC and to investigate how frequently ITCs represent part of a true metastasis. Surgical specimens from 100 patients with SCC of the esophagus were included. All original H&E stained slides containing lymph nodes were reviewed by two gastrointestinal pathologists. In lymph nodes containing ITCs, additional levels were cut and stained with a H&E- and a cytokeratin stain. Areas of tumor cells that measured >0.2 mm on the deeper sections were classified as metastases. A total of 2460 lymph nodes were examined. ITCs were detected in 10 lymph nodes (0.4%) from nine patients (9%). Deeper sections revealed metastases in five out of the 10 lymph nodes (50%). ITCs in regional lymph nodes of patients with SCC of the esophagus is a rare finding compared with patients with adenocarcinoma of the esophagogastric junction. However, deeper sections often revealed metastases. Therefore, in patients with SCC of the esophagus, we recommend additional sectioning and immunohistochemical examination of lymph nodes when ITCs are detected on the first slide.