Esophagus
Carcinoma
Adenocarcinoma


Topic Completed: 1 June 2013

Revised: 26 February 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Adenocarcinoma[TI] esophagus[TI] pathology free full text[sb]

See also: Arising in ectopic gastric mucosa, Gastroesophageal junction, Intramucosal carcinoma

Elliot Weisenberg, M.D.
Page views in 2018: 9,062
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Cite this page: Weisenberg E. Adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusadenocarcinoma.html. Accessed June 19th, 2019.
Definition / general
  • Malignant gland forming tumor of esophagus
Epidemiology
  • In developed world, incidence has increased, while incidence of squamous cell carcinoma has remained constant (Ann Oncol 2012;23:3155, J Natl Compr Canc Netw 2011;9:830)
  • 50 - 70% of esophageal carcinomas are adenocarcinoma
  • In 2013, American Cancer Society estimates 17,990 new cases of esophageal carcinoma in US with 15,210 deaths
  • Mean age is ~60 years old; cases before age 50 are uncommon
  • ~80% men
  • While the most substantial increase has been among white men, incidence is increasing in women and men of other ethnicities
  • Obesity and high BMI are strong risk factors, likely related to increased GERD and Barrett esophagus
  • Barrett esophagus is most important risk factor
  • Tobacco is moderate risk factor
  • Infection with cagA+ Helicobacter pylori appears to be protective against reflux esophagitis, the initial step in development of adenocarcinoma (pathway is reflux to Barrett esophagus to dysplasia to adenocarcinoma); increase in adenocarcinoma may be due, in part, to decline in prevalence of Helicobacter pylori (Cancer Res 1998;58:588, Cancer Prev Res (Phila) 2008;1:329)
  • H. pylori infection may cause atrophic gastritis, decreasing acid production and thus decreasing reflux disease
Sites
  • Generally in distal esophagus
  • Rarely may arise in submucosal glands or ectopic gastric mucosa
Pathophysiology
  • Dysplasia - carcinoma sequence in Barrett mucosa with stepwise accumulation of genetic mutations, especially p53 gene; additional changes involve HER2 / c-ERBB2, cyclin D1, cyclin E genes, RB, p16 genes
Clinical features
  • Insidious onset, dysphagia to solids, followed by dysphagia to all food
  • Extreme weight loss due to loss of nutrition and the tumor itself
  • Metastasis generally occurs early even in superficial tumors, due to extensive lymphatic network in esophagus that allows horizontal and longitudinal spread
  • Adenocarcinoma occurs in lower esophagus and lymph node metastases involve gastric and celiac lymph nodes
  • Visceral metastases to liver, lungs, pleura
  • Recurrences are common
Diagnosis
  • Overwhelming majority diagnosed by endoscopic biopsy
Radiology description
  • Imaging reveals mass in distal esophagus
Prognostic factors
  • Lymph node metastases, extracapsular lymph node involvement (Am J Surg Pathol 2006;30:171), depth of invasion (but see J Clin Oncol 2007;25:507), status of resection margins; possibly endoglin / CD105 (Hum Pathol 2005;36:955)
  • Postchemoradiation therapy prognostic factors in resection specimens:
    1. Extent of residual carcinoma predicts survival based on 3 groups:
    2. Prominent mucin pools in patients with Barrett associated adenocarcinoma are associated with mucinous tumors but acellular mucin pools are NOT associated with poor survival, even if at radial margin (Am J Surg Pathol 2006;30:28)
Case reports
Treatment
  • 5 year survival for nonresectable tumors is rare
  • Resection if primary treatment modality (if possible); may be preceded by neoadjuvant therapy - report Barrett metaplasia on proximal margin, if present
  • Adjuvant chemoradiation often given
Gross description
  • Usually distal esophageal tumor with invasion of gastric cardia; appears as flat patches to nodular masses; may have adjacent Barrett mucosa
Gross images


AFIP images

Adenocarcinoma in Barrett esophagus


 Contributed by
 Mark R. Wick, M.D.

In Barrett metaplasia


 Contributed by
 Dr. Elliot Weisenberg

Adenocarcinoma



Images hosted on other servers:

Polypoid tumor

Microscopic (histologic) description
  • Usually moderate or well differentiated, usually mucin producing (intestinal type mucosa), may have foci of squamous or endocrine differentiation
  • Usually has adjacent Barrett mucosa with high grade dysplasia (may be displaced by adenocarcinoma)
  • Rarely signet ring cells, papillary structures, Paneth cells, endocrine cells, pagetoid spread of tumor cells
Microscopic (histologic) images


AFIP images

Arising from Barrett epithelium


 Contributed by
 Mark R. Wick, M.D.

Metaplasia


 Contributed by
 Dr. Elliot Weisenberg

In lymphatics



Images hosted on other servers:

Arising from
Barrett epithelium:
moderately
differentiated

Adenocarcinoma / neuroendocrine carcinoma collision tumor

Positive stains
Negative stains
Electron microscopy images

Images hosted on other servers:

Adenocarcinoma (site unspecified)

Differential diagnosis
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