Esophagus cancerEsophagus cancer

Dr SaneiDr Sanei

Associated professor of pathologyAssociated professor of pathology

GI and Liver patholoogistGI and Liver patholoogist

Pathogenesis Pathogenesis food or water rich in food or water rich in nitratesnitrates and and

nitrosamines nitrosamines tobaccotobacco smokesmoke, , alcoholalcohol, and , and various various

vitamin deficiencies vitamin deficiencies achalasiaachalasia Plummer-Vinson syndromePlummer-Vinson syndrome stricturesstrictures resulting from acid or lye resulting from acid or lye

ingestion ingestion HPV types HPV types 16 and 18. 0% to 66%16 and 18. 0% to 66%

Molecular Features Molecular Features

cyclin cyclin D1 and cyclin ED1 and cyclin E p53p53, , RbRb, and , and p16p16 in up to 80% in up to 80% epidermal growth factor receptor epidermal growth factor receptor

((EGFREGFR), seen in from 29% to 92% ), seen in from 29% to 92%

SQUAMOUS DYSPLASIA SQUAMOUS DYSPLASIA lowlow grade and grade and highhigh grade grade 60% to 90%60% to 90% erythematouserythematous, , friablefriable, and , and irregularirregular in in

more than 80% more than 80% ErosionsErosions, , plaquesplaques, and , and nodulesnodules normalnormal endoscopically endoscopically reactive epithelial changesreactive epithelial changes

indefinite for dysplasiaindefinite for dysplasia chemotherapy or radiotherapychemotherapy or radiotherapy esophagitis esophagitis secondary to reflux, or secondary to reflux, or

other causes such as drug effect other causes such as drug effect

INVASIVE SQUAMOUS CELL INVASIVE SQUAMOUS CELL CARCINOMA CARCINOMA earlyearly (superficial) and (superficial) and latelate

(advanced)(advanced) middlemiddle third of the esophagus in 50% third of the esophagus in 50%

to 60% of cases to 60% of cases SuperficiallySuperficially invasive tumors are invasive tumors are

more commonly more commonly multicentricmulticentric up to up to 2020% of cases % of cases

fungatingfungating (60% of cases), (60% of cases), ulceratingulcerating (25% of cases), or (25% of cases), or infiltrativeinfiltrative (15% (15%

In patients treated with In patients treated with preoperativepreoperative radiation or chemotherapy, the tumor radiation or chemotherapy, the tumor may be may be invisibleinvisible or perhaps replaced or perhaps replaced with a with a shallow surface erosionshallow surface erosion. .

cytokeratinscytokeratins 13, 14, 18, and 1913, 14, 18, and 19.[65], [66] .[65], [66] CK7CK7 reactivity is present in up to 29% of reactivity is present in up to 29% of cases cases

majority of cases are majority of cases are negativenegative for for both both cytokeratins 7 and 20 cytokeratins 7 and 20

mostmost tumors express the tumors express the nuclear antigen p63nuclear antigen p63 Focal positivity for neuroendocrineFocal positivity for neuroendocrine markers markers

such as chromogranin and synaptophysin such as chromogranin and synaptophysin MucinMucin stains may show focal positivity stains may show focal positivity

Differential DiagnosisDifferential Diagnosis

lung squamous cell carcinomaslung squamous cell carcinomas thyroid transcription factor F1 (TTF-thyroid transcription factor F1 (TTF-1),1),

pseudoepitheliomatous hyperplasiapseudoepitheliomatous hyperplasia melanomamelanoma lymphomalymphoma pseudodiverticulosispseudodiverticulosis

VARIANTS OF SQUAMOUS VARIANTS OF SQUAMOUS CELL CARCINOMA CELL CARCINOMA

Basaloid Squamous Cell Basaloid Squamous Cell CarcinomaCarcinoma

CarcinosarcomaCarcinosarcoma

Verrucous Squamous Cell Verrucous Squamous Cell CarcinomaCarcinoma

Lymphoepithelioma-Like Lymphoepithelioma-Like CarcinomaCarcinoma

ADENOCARCINOMA ADENOCARCINOMA

More than 95% of esophageal More than 95% of esophageal adenocarcinomas develop in association adenocarcinomas develop in association with with Barrett's esophagusBarrett's esophagus

Non–Barrett's-Associated Non–Barrett's-Associated AdenocarcinomaAdenocarcinoma

extremely rare and arise either from foci extremely rare and arise either from foci of of gastric heterotopia gastric heterotopia

submucosal gland/duct systemsubmucosal gland/duct system Adenoid Cystic CarcinomaAdenoid Cystic Carcinoma

CARCINOMA WITH MIXED SQUAMOUS CARCINOMA WITH MIXED SQUAMOUS AND GLANDULAR ELEMENTS AND GLANDULAR ELEMENTS

adenoacanthomaadenoacanthoma adenosquamous carcinomaadenosquamous carcinoma mucoepidermoidmucoepidermoid carcinoma carcinoma

METASTASES METASTASES

lunglung, , breastbreast, and , and stomachstomach renal cell carcinomarenal cell carcinoma