Distal esophageal carcinomas in Chinese patients vary widely in histopathology, but adenocarcinomas remain rare

• Published in: Human pathology 2012-12, Vol.43 (12), p.2138-2148
• Main Authors: Huang, Qin, MD, PhD, Shi, Jiong, MD, PhD, Sun, Qi, MD, MS, Fan, Xiangshan, MD, MS, Feng, Anning, MD, MS, Wu, Hongyan, BS, Zhou, Qiang, BS, Yu, Chenggong, MD, PhD, Mashimo, Hiroshi, MD, PhD, Lauwers, Gregory Y., MD
• Format: Article
• Language: English
• Subjects: Abbreviations; Adenocarcinoma; Adenocarcinoma - epidemiology; Adenocarcinoma - etiology; Adenocarcinoma - pathology; Adult; Aged; Asian Continental Ancestry Group; Barrett Esophagus - complications; Barrett Esophagus - pathology; Barrett's esophagus; Biological and medical sciences; Cancer; Cancer therapies; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - etiology; Carcinoma, Squamous Cell - pathology; China; Chinese; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - etiology; Esophageal Neoplasms - pathology; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Genomes; Histology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Neuroendocrine Tumors - epidemiology; Neuroendocrine Tumors - etiology; Neuroendocrine Tumors - pathology; Other diseases. Semiology; Pathology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Prevalence; Squamous cell carcinoma; Studies; Tumors
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2012.02.018

Summary In Western countries, distal esophageal adenocarcinoma has outnumbered squamous cell carcinoma because of a dramatic increase in the prevalence of columnar-lined esophagus. Because the relative prevalence of these diseases remains unknown in China, we investigated the histopathology of distal esophageal neoplasm in resection specimens from a high-volume medical center in China. A computerized search of esophageal cancer was conducted in the pathology database between 2004 and 2010. Cancers with epicenter located within 5 cm above the gastroesophageal junction were retained for analysis. Pathology reports were reviewed along with medical, radiologic, and endoscopic records. All histology slides of selected cases were reevaluated (median, 13 per case). Conventional and basaloid squamous cell, adenosquamous, mucoepidermoid, and neuroendocrine carcinomas and esophageal adenocarcinoma were categorized according to the World Health Organization classification of esophageal cancers. The presence of columnar-lined esophagus and other pathologic changes were assessed in cases with residual esophageal mucosa. Among 1101 resections, 204 (19%) qualified for the study. Conventional and basaloid squamous cell, adenosquamous, mucoepidermoid, and neuroendocrine carcinomas and esophageal adenocarcinoma represented 76%, 11%, 3%, 2%, 6%, and 1% of the cases, respectively. Synchronous carcinomas were found in 12% and consisted of primarily squamous cell carcinoma (50%) and proximal gastric adenocarcinoma (38%). Columnar-lined esophagus was detected in 18% of the cases, among which intestinal metaplasia was present in 30% and low-grade dysplasia in 7%. In conclusion, distal esophageal carcinomas in Chinese patients showed a wide histopathologic spectrum with predominant squamous cell carcinoma and rare esophageal adenocarcinoma. Although common, columnar-lined esophagus appears pathogenetically insignificant for most distal esophageal carcinomas.