Primary Œesophageal adenocarcinoma. Confirmation of its existence by the finding of mucous gland tumours

Early Esophageal Adenocarcinoma with Non-Barrett's Columnar Epithelium Origin: Two Case Reports and a Literature Review

We herein report two cases of early esophageal adenocarcinoma derived from non-Barrett's columnar epithelium. Both patients, a 65-year-old woman and 60-year-old man, had elevated lesions on white-light imaging. Magnifying endoscopy revealed slightly irregular surface and vessel patterns, and both patients were successfully treated with endoscopic submucosal dissection. Histopathologically, both lesions comprised of well-differentiated gastric mucin phenotype adenocarcinoma. One lesion was accompanied by ectopic gastric mucosa, but the other was speculated to be ectopic gastric mucosa according to the tumor locus at the upper thoracic esophagus. Despite its rarity, endoscopists should consider the existence of adenocarcinoma derived from non-Barrett's columnar epithelium.

CA19-9-producing esophageal adenocarcinoma originating from the esophageal cardia of the mid-thoracic esophagus: a case report

BACKGROUND

Although there are many studies on primary esophageal adenocarcinoma arising from Barrett's esophagus or ectopic gastric mucosa, reports on adenocarcinoma arising from esophageal cardiac glands are extremely rare. Herein, we report a case of mid-thoracic cancer antigen 19-9 (CA 19-9)-producing primary esophageal adenocarcinoma, which presumably originated from the cardiac glands.

CASE PRESENTATION

A 74-year-old man was referred to our department with advanced esophageal cancer, which initially presented with dyspepsia. Serum levels of cancer antigen 19-9 (CA 19-9) were elevated (724.89 U/ml). Upper gastrointestinal endoscopy revealed a type 2 tumor on the posterior wall of the mid-thoracic esophagus approximately 29-32 cm from the incisor. Mucosal biopsy was consistent with a diagnosis of adenocarcinoma. Contrast-enhanced computed tomography showed a circumferential wall thickening in the mid-thoracic esophagus without enlarged lymph nodes or distant metastasis. Positron emission tomography-computed tomography showed accumulation in the primary tumor, but no evidence of lymph node or distant metastasis. According to these findings, the adenocarcinoma was staged as cT3N0M0, thereby, requiring subtotal esophagectomy with lymph node dissection. Postoperative course was uneventful. Histopathologic analysis revealed a 50 × 40 mm moderately differentiated adenocarcinoma with invasion to the thoracic duct and lymph node metastasis at #108(1/4), #109R(1/3), and #109L(1/3). After surgery, the stage was revised to moderately differentiated pT4apN2pM0 (pStage III). Immunostaining revealed expression of CA19-9 and suggested esophageal cardiac gland origin of the tumor. Three months after the surgery, the patient showed no recurrence and is undergoing outpatient observation.

CONCLUSIONS

We experienced a case of mid-thoracic CA19-9-producing primary esophageal adenocarcinoma, which was presumed to have originated in the esophageal cardiac glands. Due to the scarcity of studies regarding this condition, specific management needs to be further clarified.

A Case of Adenocarcinoma of the Upper Third of the Esophagus Arising on Ectopic Gastric Tissue

A case of adenocarcinoma of the upper third of the esophagus, arising from ectopic mucosa of gastric type, is described. The possible origins, from ectopic islets of gastric mucosa, tracheobronchial rests or esophageal glands, are discussed. The precence of ectopic gastric mucosa on the surface of the esophagus adjacent to the tumor suggests that this esophageal adenocarcinoma arose from ectopic gastric mucosa.

Adenocarcinoma arising from heterotopic gastric mucosa in the cervical esophagus and upper thoracic esophagus: two case reports and literature review

Primary adenocarcinoma arising from heterotopic gastric mucosa (HGM) is rare and the clinicopathological characteristics are not well known. We present two cases of esophageal adenocarcinoma arising from HGM with a review of a case series. Case 1 was a 78-year-old woman who underwent a periodic medical examination without complaining of any symptoms. Preoperative evaluation suggested esophageal adenocarcinoma arising from the HGM. The patient was treated with endoscopic submucosal dissection. Definitive pathological diagnosis confirmed adenocarcinoma arising from the HGM. Case 2 was a 70-year-old man who underwent a medical examination after complaining of dysphagia. Preoperative diagnosis suggested esophageal adenocarcinoma; however, its origin was unclear. The patient was treated with surgical resection. Definitive pathological diagnosis revealed adenocarcinoma arising from the HGM. In this article, the authors report the clinicopathological features of esophageal adenocarcinoma arising from HGM that were collected from a literature review and our cases.

Primary esophageal adenocarcinoma arising from heterotopic gastric mucosa: report of a case

Adenocarcinoma arising from heterotopic gastric mucosa (HGM) is exceedingly rare. This report presents the case of a 57-year-old male who presented with the chief complaint of dysphagia. Endoscopy and computed tomography revealed a locally advanced tumor of the cervical esophagus and swollen mediastinal lymph nodes. He underwent chemoradiotherapy followed by esophagectomy with three-field lymph node dissection. The resected tumor was a circumferentially scarred lesion located 1.5 cm from the proximal margin. The tumor was identified to be a well-differentiated adenocarcinoma arising from HGM with invasion to the muscularis propria. Postoperative chemoradiotherapy was performed because positive surgical margins were observed in the resected tissue. The patient has remained alive for more than 4 years after surgery, without any evidence of recurrence.

Columnar-lined esophagus: time to drop the eponym of "Barrett": Historical review

There can be few medical conditions that have been surrounded by as much confusion about their definition or terminology as columnar-lined esophagus (CLE); approximately 30 different terms and eponyms have been used to describe this condition. The history of this condition can be divided into five stages: (i) descriptive stage, 1906-1950; (ii) "argument" stage, 1950-1963; (iii) "significant" stage, 1963-1973; (iv) surveillance stage, 1973-1990; and (v) refined research stage, 1990-present. The use of the eponym "Barrett's" to describe CLE is not justified from a historical point of view. Lining of the lower esophagus by columnar epithelium was termed "Barrett's esophagus" after the presentation by Barrett in 1957. Although this finding has been attributed to Barrett, the work of others, including Tileston, Lortat-Jacob, and Allison and Johnstone, preceded Barrett's description. The historical aspects of CLE were reviewed to show how little Norman Barrett had contributed to the core concept of this condition in comparison to the contributions of other investigators, particularly the contribution of Philip Allison. Based on many discussed historical facts, we are not in favor of retaining the term "Barrett's esophagus" and we propose that CLE be henceforth referred to as "columnar-lined esophagus".

Modelling a population with Barrett's oesophagus from oesophageal adenocarcinoma incidence data

OBJECTIVE

A recent study of adenocarcinoma of the oesophagus (ACO) incidence rates in Denmark showed a steep fall in the over-80 population, interpreted as the result of a decline in the prevalence of Barrett's oesophagus (BO) in this age group, for which three hypotheses were advanced: the specific mortality from ACO and, superimposed, either excess mortality from causes of death unrelated to ACO or a birth cohort effect. The aim of this study was to create models estimating the BO population fitting each of these three hypotheses, in order to select the most plausible hypothesis and to gain insight into the Danish BO population.

MATERIAL AND METHODS

Models were designed for these three hypotheses, conforming to the generally accepted 0.4-0.5% annual ACO incidence in BO patients. These models employed expectation-maximization (EM) algorithms, Danish life tables and the observed ACO incidence rates. The models enabled the estimation of a BO population for each hypothesis.

RESULTS

After testing against set criteria, the most plausible model was found to be that describing a birth cohort effect which predicted a +/-5% annual rise in the prevalence of BO and, consequently, in the incidence rate of ACO in Denmark. This prediction was borne out over the subsequent decade.

CONCLUSIONS

This rising ACO incidence rate is likely to continue into the foreseeable future. The use of EM algorithms enabled a first estimate of the BO population at risk of ACO, although, owing to the limitations imposed by the models, the age- and gender-specific ACO risk for the entire Danish BO population could not as yet be ascertained.

Muco-epidermoid tumours of the anal canal

The pathology of 21 cases of muco-epidermoid carcinoma of the anal canal is described. These tumours are defined as squamous or transitional cell carcinomas containing areas which secrete mucin of undoubted epithelial origin within the clumps of tumour cells. They are found in that part of the anal canal just above the dentate line where the epithelium is variable in type and represents an embryological transition between rectal and squamous mucous membrane. The histogenesis of these tumours is discussed and the opinion given that they arise from the surface epithelium of the upper anal canal rather than from the anal glands.

Risk factors for the development of esophageal adenocarcinoma in Barrett's esophagus

OBJECTIVE

To identify risk factors for esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE).

METHODS

A hospital-based case-control study was performed in which 91 cases with EAC and 244 controls with histologically confirmed BE (>2 cm) with no dysplasia or low-grade dysplasia were included. Information on demographic, anthropometric, and lifestyle characteristics, physical activity levels, working posture, family history, gastroesophageal reflux disease (GERD) symptoms, and medication use was collected by questionnaire.

RESULTS

Cases more often were current smokers (odds ratio 3.7, 95% confidence interval 1.4-9.9), more often had a body mass index >25 assessed at age 20 (2.6, 1.2-5.5), and more frequently had been working in a stooped posture at age 20 (2.0, 1.1-3.9), compared to controls. In addition, cases less often experienced symptoms of heartburn (0.3, 0.2-0.5) and less frequently used proton pump inhibitors (0.1, 0.05-0.2), compared to controls, whereas use of nonsteroidal anti-inflammatory drugs/aspirin was more common among cases (1.8, 1.1-3.2). Cases more often were men, compared to controls (91%vs 67%, p < 0.001).

CONCLUSION

In patients with BE, the risk of EAC is related to risk factors for GERD, which is, however, asymptomatic. As these risk factors are common in Western countries, they are probably not helpful in individualization of surveillance intervals.

Adenocarcinoma in situ arising from the submucosal oesophageal mucous glands

The incidence of adenocarcinoma of the oesophagus is increasing; this type of carcinoma commonly arises on Barrett's oesophagus. We report a case of in-situ adenocarcinoma of the lower oesophagus arising in submucosal oesophageal mucous glands without intestinal metaplasia. We describe the histological findings, discuss the difficulties of differentiating this from invasive disease and review the current literature regarding this rare condition.

Co-occurrence of mucoepidermoid carcinoma and squamous cell carcinoma of the esophagus: report of a case

A case of co-occurrence of a mucoepidermoid carcinoma (MEC) and a squamous cell carcinoma (SCC) in the esophagus is described. The present patient was a 61-year-old man who underwent a curative esophagectomy with a regional lymph node dissection for a MEC in the lower esophagus and a SCC near the esophagogastric junction. The two lesions were endoscopically and histologically divided by a normal esophageal mucosa. The MEC of the esophagus consisted of SCC cells and signet-ring cells, and a mucin product and carcinoembryonic antigen, which were found at high levels in the blood serum before surgery, were detected histochemically in the signet-ring cells. The follow-up survey of the patients with esophageal MEC previously reported in Japan showed that most of the patients died of either local recurrence or widespread metastasis after treatment; the overall 5-year survival rate was 24.4% in the total 25 cases, and 27.7% in the 22 resected cases. However, 6 patients who died of therapeutic complications were included among these patients; furthermore, the 5-year survival rate after surgery was 29.2% in the patients treated over the last decade (1989-1998). We expect that the clinical outcome of patients treated for esophageal MEC will therefore improve in the future.

Basaloid-squamous carcinoma of the esophagus. A clinicopathologic, DNA ploidy, and immunohistochemical study of seven cases

Basaloid-squamous carcinoma (BSC) of the esophagus is a rare but interesting neoplasm that occurs primarily in the upper aerodigestive tract. In this study, we reviewed 371 cases of esophageal malignancies and detected seven cases (1.9%) of BSC. The clinicopathologic features, light and electron microscopic findings, and immunohistochemical localization of various differentiation-related antigens, including cytokeratin (CK) subtypes, p53, and epidermal growth factor receptor (EGFR), were examined. DNA ploidy was also determined in an effort to characterize the biologic features of these tumors. The tumors were classified as stage I (n = 1), IIB (n = 3), III (n = 2) or IV (n = 1). Six patients had lymph node metastasis, in four the metastatic carcinoma exhibited basaloid components. Histologically, all the tumors displayed a biphasic pattern of basaloid and squamous components. The former predominated in three cases, the latter in four cases. All the tumors contained solid growth of basaloid cells with microcystic patterns and stromal hyalinosis as well as palisading of cells. Ultrastructurally, markedly replicated basement membrane was observed. Immunohistochemistry revealed staining with only CK 14 and CK 19 antibodies in the periphery of the basaloid tumor nests. These antibodies were also positive in the basal layer of normal esophagus. Diffuse immunoreactivity for EGFR was demonstrated in all the tumors. Five tumors displayed p53 nuclear immunoreactivity. All of the basaloid components demonstrated aneuploidy by DNA image cytometry. We conclude that BSC is a distinct type of esophageal carcinoma that should be differentiated from the usual types of esophageal carcinoma and may be associated with aggressive biologic behavior.

Sclerosing mucoepidermoid carcinoma of the esophagus with intraepithelial carcinoma or dysplastic epithelium

Mucoepidermoid carcinoma of the esophagus is a particularly rare lesion, and only 24 cases have been reported in the English literature. Using histochemical methods, we identified four (3.1%) of 135 resected primary esophageal cancers as mucoepidermoid carcinomas. Gross examination of these four tumors disclosed sclerosing submucosal infiltration with shallow surface ulceration, which had appeared as a funnel-shaped constriction on esophagram. The intraepithelial spread of the tumor in two cases and the close relationship between foci of invading carcinoma and regions of dysplastic epithelium in the remaining two cases suggest that esophageal mucoepidermoid carcinoma may originate in the squamous epithelium. Although mucoepidermoid carcinoma should theoretically offer a fair prognosis, the outcome for patients with this lesion has generally been as poor as patients with typical squamous cell carcinoma. This further implies that mucoepidermoid carcinomas may arise from the squamous epithelium.

A case of basaloid-squamous carcinoma of the esophagus: immunohistochemical and ultrastructural studies

A case of basaloid-squamous carcinoma of the esophagus in an 83 year old man is reported. The esophageal tumor showed a fungating growth at the junction of the middle and lower esophagus and was composed microscopically of submucosal multiple nests with solid and cribriform-like patterns accompanied with a small focus of squamous cell carcinoma adjacent to the overlying esophageal epithelium. The structural features closely resembled those of basaloid-squamous carcinoma. The submucosal tumor cells were immunohistochemically positive for epithelial membrane antigen, wide spectral keratin, alpha actin and S-100 protein. By electron microscopy, the tumor cells had microvilli, desmosomes and bundles of myofilaments, and replicated basement membranes were frequently observed adjacent to the nests. The positive immunoreaction of S-100 protein and alpha actin and the existence of bundles of myofilaments indicated that the present tumor did not correspond well with basaloid-squamous carcinoma. In addition, there was no evidence of true glandular lumina in the tumor nests, a finding which was inconsistent with that of adenoid cystic carcinoma. From the immunoreactivity of S-100 protein and ultrastructural features, it was considered that the present submucosal tumor had originated from undifferentiated pluripotential primitive cells, which differentiated to myoepithelial cells.

Histochemistry of mucin secreting components in mucoepidermoid and adenosquamous carcinoma of the oesophagus

AIMS

To determine the direction of differentiation of the mucin secreting components in a rare group of oesophageal tumours--oesophageal squamous cell carcinomas with prominent mucin secreting components (mucoepidermoid carcinomas and adenosquamous carcinomas).

METHODS

In a review of 617 cases of primary carcinoma of the oesophagus, 16 cases of squamous cell carcinoma with prominent mucin secreting components were studied using a battery of histochemical techniques.

RESULTS

The mucin produced by these tumours was mixed and included a variable content of enzyme labile sialomucin (positive for mucicarmine, periodic acid Schiff, and alcian blue, and sensitive to sialidase digestion and negative for high iron diamine-alcian blue). Retrospective analysis of endoscopic biopsy specimens taken from these tumours showed that mucin was present in five (42%) cases.

CONCLUSIONS

The glandular component of this group of tumours histochemically differentiated in the direction of oesophageal glands: examination of the mucin secreting component in squamous cell carcinoma in resected specimens is therefore required for recording the true incidence of this type of tumour.

Basaloid-squamous carcinoma of the upper aerodigestive tract and so-called adenoid cystic carcinoma of the oesophagus: the same tumour type?

Basaloid-squamous carcinoma of the larynx, pharynx and base of tongue and the so-called adenoid cystic carcinoma of the oesophagus are rare but distinctive tumours associated with a grave prognosis. They occur most commonly in elderly males and present at an advanced stage. Our study of four such laryngeal tumours and five such oesophageal tumours shows that they are histologically and immunohistochemically identical, providing support for the idea that they are the same tumour type. They show a biphasic pattern in which basaloid tumour is intimately associated with a neoplastic squamous component which can be invasive or in situ. The basaloid component is in the form of invasive lobules with frequent comedo-necrosis and hyalinization. The constituent cells possess pale pleomorphic nuclei with frequent mitoses. Immunoreactivity for cytokeratin in the basaloid component is remarkable for its absence or weak and focal nature. Review of the literature shows that only a few cases of 'adenoid cystic carcinoma' of the oesophagus are bona fide examples of adenoid cystic carcinoma as it occurs in the salivary glands, while the others are identical to basaloid-squamous carcinoma of the upper aerodigestive tract. Their distinction is important because genuine adenoid cystic carcinoma is much less aggressive than basaloid-squamous carcinoma.

Adenosquamous carcinoma of the esophagus. A case report

A case of adenosquamous carcinoma of the esophagus is presented. This carcinoma is a typical neoplasm of the upper aerodigestive tract almost exclusively originating in squamous epithelium in continuity with minor salivary glands. It is a very rare tumor in the esophagus, and is often diagnosed as mucoepidermoid carcinoma. The differential diagnosis between them is important due to the better prognosis of the last entity. The histology and electron microscopy is described and the literature is reviewed.

Adenoid cystic carcinoma of the esophagus. A clinicopathologic study of three cases

In a group of 245 cases of primary carcinoma of the esophagus the authors found three cases of adenoid cystic carcinoma (ACC). Clinical and pathologic data of those patients (one female and two male; age range, 49-74 years) were analyzed. Tumors were localized in the middle third of the esophagus. One patient lived 15 months after surgery. Another is a case of early ACC who has been living 4.5 years after surgery and is without specific symptoms. The third patient had not had surgery and died 13 months after the onset of dysphagia. An autopsy showed only a locally invasive tumor growing into the surroundings of the esophagus, and regional lymph node metastases without distant parenchymal metastases. These findings support pathologic and biologic similarities between ACC of the esophagus and ACC of the salivary glands. There are synchronous tumors of the esophagus and the vital localization which makes the prognosis of ACC of the esophagus worse than ACC of the salivary glands.

Two cases of resected esophageal mucoepidermoid carcinoma

Two cases of resected esophageal mucoepidermoid carcinoma are described herein. Case 1, a 56-year-old man, had an ulcerous lesion of 6.5 cm in length, in the lower esophagus and a small skin tumor of 0.5 cm in diameter, in the forehead. Pathologic studies of both tumors revealed mucoepidermoid carcinoma. This case was therefore considered to be a primary tumor of the esophagus with skin metastasis. The patient was alive and well when last seen, 15 months after his operation. Case 2, a 66-year-old man, had a long ulcerous lesion of 9.0 cm in length, in the mid-thoracic and lower esophagus. The tumor had invaded the aorta and the membranous portion of the left main bronchus, and therefore complete resection was impossible. The patient died of mediastinal recurrence only 3 months after his operation in spite of postoperative irradiation. A review of the literature showed that this tumor has a much greater incidence of rapid recurrence and distant metastasis, regardless of treatment, than usual squamous cell carcinoma of the esophagus. In order to establish and accurate diagnosis of mucoepidermoid carcinoma, alcian blue and/or mucicarmin staining of the endoscopic biopsy specimen should be performed if the tumor contains both glandular and squamous cell carcinoma.

Mucoepidermoid (adenosquamous) carcinoma arising in Barrett's esophagus

A case of mucoepidermoid or adenosquamous carcinoma arising from the mucous epithelium of a Barrett's esophagus is presented. Immunohistologic examination demonstrated carcinoembryonic antigen (CEA) in both the glandular and squamous components, but keratin only in the latter. Although mucoepidermoid carcinoma of the esophagus is believed to arise from submucosal glands, heterotopic gastric surface epithelium may also give rise to this uncommon neoplasm.

Primary adenoid cystic carcinoma of the esophagus. Report of a case and its histochemical characterization

A case of primary adenoid cystic carcinoma of the esophagus was reported. A 54-year-old male patient had a tumor in the middle third of the esophagus. Barium swallow and endoscopic examination showed a protruding tumor with a shallow ulceration in its vertex. Histological examination of the surgically removed material revealed that it was largely confined to the submucosal layer, with no metastasis to lymph nodes. The tumor cells presented three distinct patterns: globular nest with irregular cystic spaces, trabecular nest, and true tubule. Electron microscopic study revealed no microvilli or triad along cystic spaces in the globular nests. Histochemical study disclosed that cystic spaces and interstitium were rich in glycosaminoglycans. The luminal surface of the true tubules of the tumor, on the other hand, was characteristically lined by sialomucins. The trabecular type-nests differed from the globular nests in showing GSA-II reactivity and containing abundant retinol-binding protein. These results indicate that the three patterns represented different differentiations of the tumor cells. Twenty-three cases of esophageal adenoid cystic carcinoma were found in the literature from 1950 to 1983 and discussed collectively.

Adenoid cystic carcinoma of the esophagus. Complete response to combination chemotherapy

A 55-year-old man had adenoid cystic carcinoma of the esophagus metastatic to the lungs and right supraclavicular fossa. He was treated with local radiation therapy to the esophagus and supraclavicular fossa, followed by combination chemotherapy with doxorubicin, mitomycin C, and 5-fluorouracil (5-FU). After a modest initial response, disease progression was noted in the pulmonary nodules. He was then treated with cisplatin, cyclophosphamide, vincristine, and doxorubicin. After two cycles of this regimen, there was complete regression of his pulmonary nodules, which was sustained for 5 months. A review of 44 literature cases of esophageal adenoid cystic carcinoma contrasted with adenoid cystic carcinoma of salivary gland origin indicated that the esophageal adenoid cystic carcinomas have a high tendency to metastasize (76% of cases) and a much poorer prognosis, with only 23% 1-year survival rate. It was concluded that esophageal adenoid carcinoma is clinopathologically distinct from the salivary gland variant, and that combination chemotherapy may be an effective treatment modality for this cancer.

Acute thoracic inlet obstruction in achalasia with adenoid cystic and squamous cell carcinoma

Respiratory symptoms due to compression of the trachea by the dilated esophagus in achalasia are extremely rare. A patient is presented whose respiratory manifestations included engorged neck veins and a neck swelling that fluctuated with respiration. He also had two malignant tumors in his dilated esophagus, a squamous cell carcinoma and an adenoid cystic carcinoma.

Glandular or mucus-secreting components in squamous cell carcinoma of the esophagus

A review of 195 patients with carcinoma of the esophagus disclosed 41 cases (21.0%) with glandular and/or mucus-secreting components, in addition to the ordinary component of squamous cell carcinoma. These tumors could be grouped into three types according to representative histologic features of glandular and mucus-secreting portions: glandular type (23 cases), cribriform type (11 cases), and mucoepidermoid type (7 cases). The histologic features of the three types were reminiscent of those of adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma of salivary glands, respectively. Moreover, areas showing glandular or mucus-secreting differentiation were in greater part located in the submucosa and the lamina propria mucosae, thereby suggesting that such differentiation had arisen in the esophageal glands or their ducts. In all 41 cases, the ordinary element of squamous cell carcinoma, invasive, or noninvasive, was admixed in various proportions with the glandular components, indicating that this type of esophageal tumor had originated not only from the covering squamous epithelium but also from esophageal mucous-gland or ductal epithelium. The findings also support the concept of the field origin of carcinogenesis in esophageal carcinoma.

Mucoepidermoid carcinoma of the esophagus--a case report

We treated a 66-year old woman with mucoepidermoid carcinoma of the esophagus. The histologic features of this tumor seemed to originate from esophageal glands and their ducts. This deduction was based on the subepithelial growth pattern and the presence of in-situ carcinoma showing a glandular or squamous pattern at the location of the esophageal gland duct. Although the biological nature of this tumor was not elucidated, the prognosis is similar to that seen with the ordinary type of esophageal squamous carcinoma.

Carcinoma of the esophagus with adenoid cystic differentiation

Adenoid cystic carcinoma of the esophagus is a relatively rare lesion which characteristically exhibits a clinically aggressive behavior. In spite of this aggressive nature, it is most often referred to as a counterpart of the more common adenoid cystic carcinoma of salivary gland origin, a comparatively indolent tumor. In this report, the clinical and pathologic findings in a series of six cases of esophageal adenoid cystic carcinomas are contrasted with those of typical salivary gland lesions, and also compared to similar tumors exhibiting "adenoid cystic" differentiation arising in other extrasalivary gland sites. It is concluded that the esophageal tumors, as well as certain similar lesions arising in other extrasalivary gland sites, represent a class of poorly differentiated basaloid neoplasms distinct both clinically and morphologically from the common adenoid cystic carcinoma of salivary gland origin.

Barrett's esophagus: a review

Barrett's esophagus may be defined as a columnar epithelium-lined distal esophagus. As a frequently recognized complication of gastroesophageal reflux, Barrett's esophagus has become a diagnosis of general clinical concern. Factors governing the development of this complication in patients with gastroesophageal reflux are unknown but may be congenitally determined in part. When symptoms are present, they are due to the complications of reflux, such as esophagitis, stricture, ulcer, or bleeding. Barrett's esophagus may be suspected on the basis of results of a barium meal test, endoscopy, or isotope scanning. Iodine staining at endoscopy or manometrically guided biopsy helps to localize the abnormal mucosal segment. The diagnosis is proved by biopsy. The columnar epithelium of Barrett's esophagus has a malignant predisposition, and, once the diagnosis is made, periodic endoscopy, with biopsy and cytologic study, is indicated. The treatment of Barrett's esophagus is directed toward objective cessation of gastroesophageal reflux. In refractory cases, antireflux surgery improves symptoms and complications from reflux, but the columnar epithelium generally persists along with its malignant potential. It is not known whether effective antireflux treatment will lower the incidence of adenocarcinoma.

"Barrett's esophagus" adenocarcinoma: a case report

A case of signet ring cell carcinoma of the lower thoracic esophagus of Barrett type without association of hiatus hernia is reported. The patient is doing well more than five years after esophagectomy combined with esophagogastrostomy. On the base of histological findings of the operative material, this tumor appears to have originated from the gastric type of mucosa with parietal cells, accessory cells and chief cells as it is lining the segment of the esophagus directly distal to the tumor. The basic anomaly in this case is believed to be misdifferentiation of the embryonic columnar epithelium to a gastric fundic type instead of a normal squamous type.

Adenoid cystic carcinoma of the esophagus: a light and electron microscopic study

The light and electron microscopic appearances of adenoid cystic carcinoma of the esophagus are presented. Typical light microscopic features of adenoid cystic carcinoma were seen, but a unique additional feature was the presence at one edge of the tumor of gland-like structures lined entirely by tumor cells and opening onto an intact esophageal epithelium. Electron microscopy showed cystic spaces containing replicated basement membrane surrounded by epithelial cells with occasional myoepithelial cells at the interface. Rare lumina were seen between the cells with microvilli projecting into them. Occasional epithelial cells contained granules of neurosecretory tape. Both the light and electron microscopic findings strongly support an origin from the intercalated duct of esophageal mucus glands. The paucity of gland lumina may represent a lesser degree of differentiation which would accord well with the known biological aggressiveness of the tumor at this site.

Primary adenoid cystic carcinoma of the esophagus: report of a case

A case of primary adenoid cystic carcinoma of the esophagus is reported. A 51-year-old male patient had a tumor in the lower third of the esophagus which was incidentally found during an examination for cholelithiasis, and resected successfully. The tumor exhibited a polypoid appearance covered by normal esophageal epithelium, localized entirely in the submucosal layer, and morphologically identical to adenoid cystic carcinoma in the salivary glands. The patient is still alive and well three and one-half years after surgery. This seems to be a typical case of adenoid cystic carcinoma of the esophagus arising from the submucosal esophageal gland.

Primary adenocarcinoma of the upper oesophagus

Adenocarcinoma of the upper one-third of the oesophagus is an uncommon entity. A review of the literature reveals 20 reported cases. This paper reports an additional case. The lesion may arise from oesophageal glands, foci of ectopic gastric mucosa, or a Barrett's oesophagus. In contrast with squamous cell carcinomas submucosal spread is not prominent; however, transverse penetration through the oesophageal wall is common. The prognosis is grave. Treatment modalities that have been employed include supportive care, surgery alone, pre-operative radiation therapy and surgery and radiation therapy alone. Survival statistics produced by these various regimens are similar. There is little documented evidence for the radioresponsiveness of primary adenocarcinoma of the oesophagus. The case described demonstrates marked tumour regression following a course of external radiotherapy as shown by serial oesophagrams. Optimum treatment for adenocarcinoma of the upper oesophagus remains to be determined. It is felt that the role of radiation therapy should be further evaluated.

Adenocarcinoma of the oesophagus and of the oesophagogastric junction

The clinical and pathological features of 52 adenocarcinomas invading the oesophagus and the oesophagogastric junction are reviewed. The relationship of these tumours to the presence of a concomitant hiatal hernia and the histogenesis of primary oesophageal adenocarcinomas are discussed. Adenocarcinomas of the cardio-oesophageal junction appear to have distinctive prognostic and pathological features and there may be a case for their classification into a separate category of alimentary neoplasms.

Mucoepidermoid carcinoma of the esophagus: a case report

The eighth reported case of mucoepidermoid carcinoma of the esophagus is described by light microscopic and ultrastructural examination. The reason of such a paucity of reports, the probable origin, and the natural history of this neoplasm are examined through our observations and reference to the literature.

Adenoid cystic carcinoma of the oesophagus

A case of adenoid cystic carcinoma of the oesophagus occurring in a patient who had previously been treated for craniopharyngioma is presented. This is the thirteenth reported case of adenoid cystic carcinoma of the oesophagus and the first in association with craniopharyngioma. The previously described cases of oesophageal adenoid cystic carcinoma are critically reviewed, and it is suggested that this tumour is in general highly malignant and may not be so rare as is generally thought.