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GI Path Online Pathology of Squamous Cell Carcinoma of the Esophagus
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Superficial carcinoma:
The term 'early squamous cell carcinoma of the oesophagus', which was previously restricted to superficial carcinoma with no lymph node metastasis, now encompasses intramucosal carcinoma regardless of the nodal status. - Intramucosal carcinoma- Tumour does not invade beyond lamina propria. - Superficial or microinvasive carcinoma - Tumour does not invade beyond submucosa. - Superficial spreading carcinoma- Lateral intramucosal spread of atleast 2 cm or more beyond invasive lesion. - Gross features of superficial carcinoma- Verrucous, polypoid, coarse, ulcerative and infiltrating. The polypoid variant is more likely to infiltrate into the submucosa and are associated with metastasis. -Metastases- 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 survival 50%
Invasive Squamous cell carcinoma : Age: Usually in middle aged and elderly male (over 50 years). Incidence: Highest incidence in China, Iran, Russia and South Africa. Etiological factors: 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). Presentation: Dysphagia, obstruction, hemorrhage, sepsis secondary to ulceration, fistula formation into respiratory tree with aspiration. Site: Upper esophagus (20%), middle (50%), lower (30%). Macroscopic features: Exophytic polypoid (60%), circumferential, ulcerating , diffusely infiltrative tumour.
Verrucous squamous cell carcinoma Verrucous carcinoma is a slow growing, well differentiated, rare form of squamous carcinoma variant. 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 nutcracker esophagus. 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. Macroscopic feature: Large, warty mass with pushing margin. Microscopic features: 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.
Basaloid 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. Prominent stromal 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. |
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