The term 'early
carcinoma of the
was previously restricted to superficial
no lymph node metastasis, now encompasses intramucosal
regardless of the nodal status.
Tumour does not invade beyond lamina propria.
or microinvasive carcinoma -
Tumour does not invade beyond submucosa.
- Superficial spreading carcinoma-
Lateral intramucosal spread of atleast 2 cm
or more beyond invasive lesion.
features of superficial carcinoma-
Verrucous, polypoid, coarse, ulcerative and
The polypoid variant is more likely to infiltrate into the submucosa and
are associated with metastasis.
In Carcinoma in-situ and intramucosal
carcinoma. Almost no evidence of nodal metastases. 5 year survival 100%.
In superficial carcinoma: 20-50% cases metastasize. 5 year
Invasive Squamous cell carcinoma
Usually in middle aged and elderly male (over
Highest incidence in China, Iran, Russia and
Alcohol, tobacco, betel chewing, fungal contamination of food, vitamin
deficiency (A, C, riboflavin, thiamine) , long standing esophagitis,
achalasia, celiac disease, Plummer- Vinson syndrome, tylosis (non
epidermolytic palmoplantar keratoderma), human papillomavirus infection (
types 16 and 18).
Dysphagia, obstruction, hemorrhage, sepsis
secondary to ulceration, fistula formation into respiratory tree with
Upper esophagus (20%), middle (50%), lower (30%).
polypoid (60%), circumferential, ulcerating ,
diffusely infiltrative tumour.
Verrucous squamous cell carcinoma
Verrucous carcinoma is
a slow growing, well differentiated, rare form of squamous carcinoma
It is associated with
chronic, local disease process and it invades locally.
Risk factors may
include smoking, alcohol abuse, hiatal hernia, achalasia, esophagitis,
caustic injury from kerosene ingestion, esophageal diverticulum or
Few reported cases have
shown the association with the HPV virus.
The incidence rate is
higher in male as compared to female with a ratio of approx 2:1.
Common presenting sign
and symptoms in the verrucous carcinoma of the esophagus are dysphagia
and weight loss.
Large, warty mass with pushing margin.
Range from well to poorly differentated
squamous cell carcinoma.
Verrucous squamous cell carcinoma- Well differentiated
type shows - bulbous proliferation of squamous epithelium. Cells demonstrate minimal atypia.
squamous cell carcinoma (BSCC)
The majority of esophageal
BSCC cases were previously diagnosed as adenoid cystic carcinoma.
It is histologically
characterized by solid nests of cells with
pale nuclei and comedo-type necrosis, microcystic spaces with containing basophilic material,
peripheral palisading is not prominent.
hyalinization present in some cases. These features are partly reminiscent
of basal cell carcinoma of the skin
Foci of necrosis and
numerous mitotic figures are present.