Esophageal cancer pathophysiology: Difference between revisions

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Revision as of 15:16, 14 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

The pathophysiology of esophageal cancer depends on the histological subtype.

Pathophysiology

The esophagus is lined by nonkeratinized stratified squamous epithelium. This lining is maintained as long as there are no stressors leading to a metaplastic change. These stressors may include genetic factors, chronic alcoholism, smoking, ingesting spicy foods and hot liquids frequently, and chronic gastroesophageal reflux. Eventually, a dysplastic change occurs followed by a metaplastic change, which may be squamous cell carcinoma or adenocarcinoma.^[1]

Pathology

Gross pathology

Squamous cell carcinoma or adenocarcinoma of the esophagus may appear as:^[2]

Flat and irregular plaque
Polypoid lesion
Ulcerating, fungating mass.
- Location:
  - Squamous cell carcinoma is usually found in the mid-third of the esophagus
  - Adenocarcinoma is usually found in the lower third of the esophagus near the gastric opening.

Microscopic pathology

Nuclear atypia of malignancy:

Found in both types:

Squamous cell carcinoma

Atypical squamous cells invade the basement membrane ^[3]
- Cytology of squamous cells:
  - Nucleus - typically central
  - High mitotic activity
  - Eosinophilic cytoplasm
  - Squamous whorls or keratin pearls

Adenocarcinoma

Atypical adenomatous cells show:
- Invading cell clusters or glands^[4]
- Cribriforming
- desmoplasia
- Invasion (into submucosa)

References

↑ Quante M, Graham TA, Jansen M (2017). "Insights into the Pathophysiology of Esophageal Adenocarcinoma". Gastroenterology. doi:10.1053/j.gastro.2017.09.046. PMID 29037468.
↑ Sugarbaker, David (2015). Adult chest surgery. New York: McGraw-Hill Education. ISBN 0071781897.
↑ "Squamous cell carcinoma of the esophagus".
↑ "Esophageal adenocarcinoma".

Template:WikiDoc Sources

[pmid29037468-1] Quante M, Graham TA, Jansen M (2017). "Insights into the Pathophysiology of Esophageal Adenocarcinoma". Gastroenterology. doi:10.1053/j.gastro.2017.09.046. PMID 29037468.

[2] Sugarbaker, David (2015). Adult chest surgery. New York: McGraw-Hill Education. ISBN 0071781897.

[3] "Squamous cell carcinoma of the esophagus".

[4] "Esophageal adenocarcinoma".

[1]

[2]

[3]

[4]

@@ Line 14: / Line 14: @@
 ===Gross pathology===
-[[Squamous cell carcinoma]] or [[adenocarcinoma]] of the [[esophagus]] may appear as:
+[[Squamous cell carcinoma]] or [[adenocarcinoma]] of the [[esophagus]] may appear as:<ref>{{cite book | last = Sugarbaker | first = David | title = Adult chest surgery | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 0071781897 }}</ref>
 * Flat and irregular [[plaque]]
 * Polypoid lesion
@@ Line 20: / Line 21: @@
 ** Location:
 *** Squamous cell carcinoma is usually found in the mid-third of the esophagus
-*** Adenocarcinoma is usually found in the lower third of the esophagus near the gastric opening.<ref>{{cite book | last = Sugarbaker | first = David | title = Adult chest surgery | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 0071781897 }}</ref>
+*** Adenocarcinoma is usually found in the lower third of the esophagus near the gastric opening.
 ===Microscopic pathology===
@@ Line 33: / Line 33: @@
 ====Squamous cell carcinoma====
-Atypical squamous cells with invasion through the [[basement membrane]]:
+*Atypical squamous cells invade the [[basement membrane]] <ref>{{Cite web | title =Squamous cell carcinoma of the esophagus| url =http://librepathology.org/wiki/index.php/Squamous_cell_carcinoma_of_the_esophagus }}</ref>
-*Cytology:
+**Cytology of squamous cells:
-**Nucleus - typically central
+***Nucleus - typically central
-**Mitotic activity
+***High mitotic activity
-**Cytoplasm - "dense-appearing", typically [[Staining|eosinophilic]] (may be intensely eosinophilic)
+***Eosinophilic cytoplasm
-**Squamous whorls or ''keratin pearls'' may be present<ref>{{Cite web | title =Squamous cell carcinoma of the esophagus
+***Squamous whorls or ''keratin pearls''
- | url =http://librepathology.org/wiki/index.php/Squamous_cell_carcinoma_of_the_esophagus }}</ref>
 [[Image:ssc.jpg|thumb|center|1000px|Esophageal squamous cell carcinoma by Nephron - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=31284085]]
-====Adenocarcinoma<ref>{{Cite web | title =Esophageal adenocarcinoma| url =http://librepathology.org/wiki/index.php/Esophageal_adenocarcinoma#Microscopic }}</ref>====
+====Adenocarcinoma====
-*Invading cell clusters or [[Gland|glands]]
-*Cribriforming (more than rare) or [[desmoplasia]] or "deep" invasion (into submucosa)
+*Atypical adenomatous cells show:
+**Invading cell clusters or [[Gland|glands]]<ref>{{Cite web | title =Esophageal adenocarcinoma| url =http://librepathology.org/wiki/index.php/Esophageal_adenocarcinoma#Microscopic }}</ref>
+**Cribriforming
+**[[desmoplasia]]
+**Invasion (into submucosa)
 [[Image:Ac.jpg|thumb|center|1000px|Esophageal adenocarcinoma by Nephron - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=12475495]]