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Li Y, Liu L, Pan Y, Fang F, Xie T, Cheng N, Guo C, Xue X, Zeng H, Xue L. Integrated molecular characterization of esophageal basaloid squamous cell carcinoma: a subtype with distinct RNA expression pattern and immune characteristics, but no specific genetic mutations. J Pathol 2023; 259:136-148. [PMID: 36371676 DOI: 10.1002/path.6028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/09/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022]
Abstract
Esophageal basaloid squamous cell carcinoma (bSCC) is a subtype of squamous cell carcinoma (SCC) with a different behavior and poor prognosis. Exploring bSCC's molecular characteristics and treatment strategies are of great clinical significance. We performed multi-omics analysis of paired bSCC and common SCC (cSCC) using whole exome sequencing and a NanoString nCounter gene expression panel. Immunohistochemistry was used for verification of candidate biomarkers. Different treatment response was analyzed on both patients receiving neoadjuvant treatment and late-stage patients. The common genetically-clonal origin of bSCC and cSCC was confirmed. No significant differences between their genetic alterations or mutation spectra were observed. Mutation signature 15 (associated with defective DNA damage repair) was less prominent, and tumor mutational burden (TMB) was lower in bSCC. bSCC with an RNA expression pattern resembling cSCC had a better survival than other bSCCs. Moreover, bSCC showed significant upregulation of expression of genes associated with angiogenesis response, basement membranes, and epithelial-mesenchymal transition, and downregulation of KRT14 (squamous differentiation) and CCL21 (associated with immune response). Immunohistochemistry for SFRP1 was shown to be highly sensitive and specific for bSCC diagnosis (p < 0.001). In addition, bSCC receiving neoadjuvant immuno-chemotherapy had a worse pathological response than bSCC receiving neoadjuvant chemotherapy (but without statistical significance), even in bSCC positive for PD-L1. Our results demonstrated the molecular characteristics of esophageal bSCC as a subtype with a distinct RNA expression pattern and immune characteristics, but no specific genetic mutations. We provided a useful biomarker, SFRP1, for diagnosis. After outcome analysis for six bSCCs with neoadjuvant immunotherapy treatment and four late-stage bSCCs with immunotherapy, we found that immunotherapy may not be an effective treatment option for most bSCCs. This may also provide a clue for the same subtypes of lung and head and neck cancer. Our study highlighted the heterogeneity among bSCC patients, and might explain the conflicting results of bSCC outcomes in existing studies. © 2022 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Yan Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China
| | - Linxiu Liu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China.,Department of Pathology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, PR China
| | - Yi Pan
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China
| | - Fang Fang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China.,Department of Pathology, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Tongji Xie
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Na Cheng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China
| | - Changyuan Guo
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China
| | - Xuemin Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China
| | - Hua Zeng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, PR China.,Center for Cancer Precision Medicine, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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Jiang D, Wang H, Deng M, Song Q, Liu Y, Peng R, Xu L, Su J, Xu C, Hou Y. A comparative analysis of clinicopathological factors and survival between esophageal basaloid squamous cell carcinoma and conventional esophageal squamous cell carcinoma. Eur J Surg Oncol 2022; 49:958-963. [PMID: 36588005 DOI: 10.1016/j.ejso.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/17/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Recently, the number of diagnosed esophageal basaloid squamous cell carcinoma (EBSCC) has gradually increased. However, available data on EBSCC are limited to date. METHODS A total of 165 EBSCC (Cohort 1) and 515 conventional esophageal squamous cell carcinoma (ESCC) (Cohort 2) were retrospectively analyzed. RESULTS In Cohort 1, 70 cases only had invasive EBSCC component (42.4%, defined as Group 1), 73 cases had concomitant invasive ESCC component (44.2%, Group 2), and 22 had concomitant invasive poor-differentiated component (13.3%, Group 3). Lymph node metastasis rates of Group 3, Group 2 and Group 1 were ranked from high to low (P = 0.044). There were higher patient age (P = 0.047), smaller tumor size (P = 0.009), more nerve invasion (P < 0.001), and lower pTNM stage (P < 0.001) in EBSCC (Cohort 1), compared with ESCC (Cohort 2). In Cohort 1 and Cohort 2, pTNM stage was an independent prognostic factor for both DFS and OS. No significant survival difference was found between EBSCC (Cohort 1) and ESCC (Cohort 2) in pIA-B stage, pIIA-B stage, pIIIA-B stage and pIVA-B stage (P > 0.05). CONCLUSION Our analysis of the largest EBSCC series from a single institution to date with conventional ESCC demonstrated that EBSCC carried a similar prognosis with ESCC in pIA-B stage, pIIA-B stage, pIIIA-B stage and pIVA-B stage. And pure EBSCC, didn't have poorer survival than mixed EBSCC with concomitant ESCC or other components. Our findings may be valuable in the better understanding of EBSCC's biological behaviors, and the related molecular mechanism is needed to be explored in the future.
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Affiliation(s)
- Dongxian Jiang
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haixing Wang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minying Deng
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Song
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yufeng Liu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rui Peng
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Xu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jieakesu Su
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Xu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingyong Hou
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
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Yanai Y, Hayashi T, Tsuyama S, Nasu M, Hashimoto T, Kajiyama Y, Tsurumaru M, Mine S, Orita H, Fukunaga T, Yao T, Saito T. Clinicopathological and mutational analysis of esophageal basaloid squamous cell carcinoma. Virchows Arch 2022; 481:477-487. [PMID: 35641667 DOI: 10.1007/s00428-022-03350-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/27/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
Esophageal basaloid squamous cell carcinoma (EBSCC) is a poorly differentiated variant of esophageal squamous cell carcinoma (ESCC). We aimed to investigate the clinicopathological and molecular biological characteristics of EBSCC and enrolled 58 patients with EBSCCs. Clinicopathological factors including age, sex, tumor size and location, gross tumor type (superficial, protrusive, ulcerative, and unclassifiable), lymphovascular invasion, infiltrative growth, intramural invasion, TNM stage, and dominant histological type were examined. EBSCCs were classified into four types (solid, cribri, microcystic, and tubular) according to the dominant histology. Next-generation sequencing (NGS) of a cancer hotspot panel was performed in 19 cases. NGS identified TP53 as the most frequently mutated gene, and copy number variation analysis revealed the most frequent loss of heterozygosity (LOH) at the ataxia telangiectasia mutated (ATM) and retinoblastoma 1 (RB1) loci. Target sequencing for TP53 was performed for the remaining 39 cases. We also performed LOH analysis for TP53, ATM, and RB1 and immunohistochemical staining for p53, ATM, and Rb in all cases. The rates of TP53 mutations and LOH and p53 aberrant expression were high (79.3%, 63.2%, and 72.4%, respectively); however, the frequencies were similar to those reported for ESCC. LOH rates of the RB1 and ATM loci were also high (55.3% and 67.2%, respectively). Overall survival rate was 66.5%, and recurrence-free survival rate was 55.0%. Only conventional clinicopathological factors had a prognostic impact in EBSCC; the microcystic type had the poorest prognosis. Our findings could be useful in developing novel treatment strategies for EBSCC.
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Affiliation(s)
- Yuka Yanai
- Department of Human Pathology, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Sho Tsuyama
- Department of Human Pathology, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Motomi Nasu
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Takashi Hashimoto
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Yoshiaki Kajiyama
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Masahiko Tsurumaru
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Hajime Orita
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Intractable Disease Research Center, Juntendo University, Graduate School of Medicine, Tokyo, 113-8421, Japan.
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Feng JF, Zhao JM, Yang X, Wang L. The Prognostic Impact of Preoperative Serum Apolipoprotein A-I in Patients with Esophageal Basaloid Squamous Cell Carcinoma. Cancer Manag Res 2021; 13:7373-7385. [PMID: 34588815 PMCID: PMC8474064 DOI: 10.2147/cmar.s328138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 01/17/2023] Open
Abstract
Background Esophageal basaloid squamous cell carcinoma (EBSCC) is a rare malignancy. Serum apolipoprotein A-I (APO A-I) has proved to be a potentially useful prognostic indicator in various cancers. However, no studies have analyzed the prognostic significance of serum APO A-I in patients with EBSCC. The aim of this study was to investigate the prognostic impact of preoperative serum APO A-I in patients with EBSCC. Methods Between 2007 and 2018, a retrospective study of 4050 patients with resectable esophageal squamous cell carcinoma (ESCC) including the levels of preoperative serum lipids was conducted and evaluated. The best cut-off values of the preoperative serum lipids were evaluated by receiver operating characteristic (ROC) curves. Kaplan–Meier analyses and Cox regression analyses were analyzed the overall survival (OS) and recurrence-free survival (RFS). A prediction model of nomogram was developed to predict individual OS and RFS in EBSCC. Results There were 53 patients enrolled in the study, which accounted for 1.31% (53/4050) of all primary ESCC. The best cut-off point was 1.305 g/L for serum APO A-I according to the ROC curve. Patients with lower levels of serum preoperative APO A-I were associated with worse RFS (16.1% vs 54.5%, P = 0.006) and OS (29.0% vs 63.6%, P = 0.010). The results indicated that serum APO A-I serves as an independent predictor in patients with EBSCC regarding OS [hazard ratio (HR): 0.352; 95% confidence interval (CI): 0.154–0.808; P = 0.014] and RFS (HR: 0.397; 95% CI: 0.185–0.850; P = 0.017). Conclusion Preoperative serum APO A-I is an independent predictor regarding OS and RFS in EBSCC. As far as we know, this is the first study in EBSCC to explore the serum APO A-I in patients with EBSCC.
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Affiliation(s)
- Ji-Feng Feng
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jian-Ming Zhao
- Department of Thoracic Surgery, Jinhua Guangfu Hospital, Jinghua, Zhejiang Province, People's Republic of China
| | - Xun Yang
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, People's Republic of China
| | - Liang Wang
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, People's Republic of China
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5
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Xu Y, Zhao H, Tong Y, Wang W, Huang J, Zhu W. Comparative Analysis of Clinicopathological Characteristics, Survival Features, and Protein Expression Between Basaloid and Squamous Cell Carcinoma of the Esophagus. Int J Gen Med 2021; 14:3929-3939. [PMID: 34345181 PMCID: PMC8323856 DOI: 10.2147/ijgm.s314054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/26/2021] [Indexed: 01/02/2023] Open
Abstract
Background Basaloid squamous cell carcinoma (BSCC) is a rare variant of squamous cell carcinoma (SCC) of the esophagus. This study aimed to assess the discrepancy in clinicopathological characteristics and protein expression between esophageal BSCC and typical esophageal SCC. Study Design We reviewed 40 cases of esophageal BSCC. As controls, 63 well-differentiated SCC (WSCC) patients, 70 moderately differentiated SCC (MSCC) patients, and 51 poorly differentiated SCC (PSCC) patients were selected. The clinicopathologic characteristics and immunoreactivity of Ki-67, p53, p63, and epidermal growth factor receptor (EGFR) were then evaluated in the BSCC and typical SCC patients. Results The 5-year survival rates for the BSCC patients were 27.5%. The prognostic outcomes of the BSCC group were similar to those of the PSCC and MSCC groups but worse than that of the WSCC group, with a significant difference (P=0.045). Ki-67 expression was significantly higher in the BSCC group than that in the WSCC group (P < 0.05). Meanwhile, there were no significant differences in the expression of the other molecular markers (p53, p63, and EGFR) between the typical SCC and BSCC groups (P > 0.05). The median survival time of esophageal the BSCC patients with low p53 expression was significantly longer than that of the patients with high p53 expression (P=0.026). Further, the median survival time of the esophageal BSCC patients with high p63 expression was significantly longer than that of the patients with low p63 expression (P=0.041). Meanwhile, Ki-67 and EGFR expressions were not correlated with OS in the BSCC group. Conclusion Esophageal BSCC has a more clinically virulent course. Notably, p53 and p63 expression are associated with prognosis in BSCC. These findings conject that evaluation of multiple cancer biomarkers might be a promising auxiliary diagnostic indicator in BSCC.
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Affiliation(s)
- Yingying Xu
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
| | - Huanyu Zhao
- Department of Pathology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
| | - Yusuo Tong
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
| | - Wanwei Wang
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
| | - Jing Huang
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
| | - Weiguo Zhu
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, 223300, People's Republic of China
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Savant D, Zhang Q, Yang Z. Squamous Neoplasia in the Esophagus. Arch Pathol Lab Med 2021; 145:554-561. [PMID: 32271610 DOI: 10.5858/arpa.2020-0058-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Squamous lesions of the esophagus encompass a spectrum of disorders ranging from reactive changes and benign papilloma to squamous dysplasia and squamous cell carcinoma, which may pose diagnostic challenges especially in superficial biopsies. OBJECTIVE.— To provide a review on the typical features of squamous neoplasia in the esophagus, with an emphasis on the key diagnostic features as well as differential diagnosis from mimicking lesions. DATA SOURCES.— Data sources include published peer-reviewed literature and personal experiences of the authors. CONCLUSIONS.— Accurate diagnosis of squamous neoplasia requires adherence to established diagnostic criteria, attention to subtle histologic features, and correlation with clinical and imaging findings. In difficult cases, multiple biopsies may be necessary to reach a definitive diagnosis.
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Affiliation(s)
- Deepika Savant
- The Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (Savant, Yang)
| | - Qingzhao Zhang
- The Department of Pathology, Penn State Health Hershey Medical Center, Hershey, Pennsylvania (Zhang)
| | - Zhaohai Yang
- The Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (Savant, Yang)
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Endo F, Akiyama Y, Onishi M, Uesugi N, Sugai T, Sasaki A. Cutaneous metastasis from esophageal basaloid squamous cell carcinoma: A case report. Int J Surg Case Rep 2021; 80:105621. [PMID: 33596520 PMCID: PMC7893449 DOI: 10.1016/j.ijscr.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/09/2022] Open
Abstract
Cutaneous metastasis of esophageal cancer is rare. Basaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare histologic variant of squamous cell carcinoma. We reported a case of cutaneous metastasis from esophageal BSCC and was successfully treated with multidisciplinary treatment.
Introduction and importance Basaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare histologic variant of squamous cell carcinoma. Here, we reported a case of solitary cutaneous metastasis as the first symptom of esophageal BSCC and was successfully treated with multidisciplinary treatment. Case presentation A 67-year-old man visited a local hospital with symptoms of dysphagia and cutaneous nodules on his left shoulder. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed hypermetabolic accumulations in the middle thoracic esophagus, right recurrent laryngeal nerve lymph node, and epidermis of the left shoulder. Esophagogastroscopy revealed an ulcerative and infiltrating type tumor in the middle thoracic esophagus. Based on histopathologic examination of the endoscopic biopsy and the resected cutaneous tumor, the patient was diagnosed as esophageal BSCC with cutaneous metastasis. The patient was treated with chemotherapy followed by chemoradiotherapy. The therapeutic effect was a complete response, which was sustained for 39 months. Clinical discussion Review of previous literature in the PubMed database revealed only been two case reports on cutaneous metastasis of BSCC. Advanced BSCC of the esophagus with distant metastasis has a poor prognosis. Therefore, in our case, future careful follow-up is required. Conclusion Esophageal BSCC with cutaneous metastasis can be successfully managed by multidisciplinary treatment, including local resection of the cutaneous metastasis, systemic chemotherapy, and chemoradiotherapy.
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Affiliation(s)
- Fumitaka Endo
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Yuji Akiyama
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Masazumi Onishi
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
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Song H, Tetangco E, Ton L, Barrett A, Yap JEL. Beyond Squamous Cell Carcinoma: Basaloid Squamous Cell Carcinoma of the Esophagus. Cureus 2021; 13:e12619. [PMID: 33585108 PMCID: PMC7872487 DOI: 10.7759/cureus.12619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Basaloid squamous cell carcinoma (BSCC) is a poorly differentiated variant of squamous cell carcinoma (SCC) with distinct morphologic characteristics. Yet, there are no clearly defined guidelines established for management. BSCC in the esophagus is a very rare entity, with the proportion of esophageal BSCC ranging from 0.068% to 11%. This wide range is thought to be secondary to difficulty making the diagnosis on small biopsy specimens and the lack of a universally defined proportion of BSCC components necessary to make the diagnosis. We present the case of a 57-year-old African American female, who underwent esophagogastroduodenoscopy (EGD) after an abnormal barium swallow in the setting of two months history of dysphagia and weight loss and was diagnosed with BSCC of the esophagus on histopathology.
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Affiliation(s)
- Heeyah Song
- Medicine, Medical College of Georgia at Augusta University, Augusta, USA
| | - Eula Tetangco
- Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
| | - Loc Ton
- Gastroenterology, The Permante Medical Group, Sacramento, USA
| | - Amanda Barrett
- Pathology, Medical College of Georgia at Augusta University, Augusta, USA
| | - John Erikson L Yap
- Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
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Businello G, Parente P, Mastracci L, Pennelli G, Traverso G, Milione M, Bellan E, Michelotto M, Kotsafti A, Grillo F, Fassan M. The Pathologic and Molecular Landscape of Esophageal Squamous Cell Carcinogenesis. Cancers (Basel) 2020; 12:cancers12082160. [PMID: 32759723 PMCID: PMC7465394 DOI: 10.3390/cancers12082160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 02/07/2023] Open
Abstract
Esophageal squamous cell carcinoma represents the most common histotype of epithelial neoplasm occurring within esophageal mucosa worldwide. Despite the comprehensive molecular characterization of this entity, to date no significant targeted therapy has been introduced into clinical practice. In this review, we describe the molecular landscape of esophageal squamous cell carcinoma based on the most recent literature. Moreover, we focus on other rare variants and on the relationship with head and neck squamous cell carcinomas.
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Affiliation(s)
- Gianluca Businello
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (G.B.); (G.P.); (E.B.); (M.M.)
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo FG, Italy;
| | - Luca Mastracci
- Anatomic Pathology, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy; (L.M.); (F.G.)
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy;
| | - Gianmaria Pennelli
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (G.B.); (G.P.); (E.B.); (M.M.)
| | | | - Massimo Milione
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy;
| | - Elena Bellan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (G.B.); (G.P.); (E.B.); (M.M.)
| | - Mauro Michelotto
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (G.B.); (G.P.); (E.B.); (M.M.)
| | - Andromachi Kotsafti
- Laboratory of Advanced Translational Research, Veneto Institute of Oncology IOV–IRCCS, 35128 Padua, Italy;
| | - Federica Grillo
- Anatomic Pathology, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy; (L.M.); (F.G.)
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy;
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (G.B.); (G.P.); (E.B.); (M.M.)
- Correspondence: or ; Tel.: +39-49-821-1312; Fax: +39-49-827-2277
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Liu L, Xue X, Xue L. Liver metastatic basaloid squamous cell carcinoma with negative expression of pancytokeratin: a case report and literature review. Diagn Pathol 2019; 14:102. [PMID: 31488173 PMCID: PMC6729002 DOI: 10.1186/s13000-019-0881-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma with a high rate of distant metastasis. BSCC occurs most commonly in the esophagus, lungs, and head and neck. However, BSCC occurring in an atypical site without a known primary tumor and/or with the presence of atypical immunohistochemical features can result in delayed diagnosis or misdiagnosis. Case presentation Here, we report a case of a 67-year-old man with liver metastatic BSCC with negative pancytokeratin (AE1/AE3) expression. He presented with a chief complaint of epigastric discomfort. Imaging examination revealed a subcapsular mass in the right anterior lobe of the liver. Then, the patient underwent an irregular right hepatectomy. Grossly, the mass was gray, with a size of 7 × 7 × 4 cm. Microscopically, the mass comprised epithelioid tumor cells with both solid and pseudoadenoid structures, accompanied by necrosis. Immunohistochemical staining showed that the tumor cells were negative for AE1/AE3, CK18, CK7, CK19, Hepatocyte Paraffin-1, Glypican-3, Arginase-1, CD56, Chromogranin A, Synaptophysin, Vimentin, and Carcinoembryonic antigen. The Ki-67 index was 80%.The mass was diagnosed as a malignant tumor but could not be classified further. One month after surgery, the patient’s reexamination revealed esophageal tumor, and biopsy revealed BSCC. The slides of the liver tumor were reviewed, and the morphology was similar to that of the esophageal tumor. Moreover, supplementary immunohistochemical staining of liver tumor indicated p63 and p40 were strongly positive, that confirmed the liver tumor was metastatic BSCC. Previous studies have reported that 3.7% of esophageal BSCCs did not express AE1/AE3. Conclusion When a malignant tumor comprises epithelioid cells with solid and/or pseudoadenoid structures, but not adenocarcinoma or neuroendocrine carcinoma, even if the tumor cells are negative or weakly positive for AE1/AE3, we should consider BSCC. For a definite diagnosis, immunohistochemical staining for squamous cell carcinoma markers, including p63 and p40, and examination of common primary sites of BSCC should be performed.
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Affiliation(s)
- Linxiu Liu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuemin Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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11
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Di L, Fu KI, Wu X, Liu X, Xie R, Zhu R, Tuo B. Endoscopic features and associated histology of an basaloid squamous cell carcinoma of the esophagus at the very early stage. BMC Cancer 2019; 19:513. [PMID: 31142308 PMCID: PMC6542137 DOI: 10.1186/s12885-019-5749-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/24/2019] [Indexed: 01/18/2023] Open
Abstract
Background Basaloid squamous cell carcinoma of the esophagus (BSCCE) is generally detected at advanced stage and the prognosis is poorer than advanced conventional esophageal squamous cell carcinoma. Therefore, early detection is a critical to improve patients’ survival. However, only a few cases of early BSCCE have been reported and the endoscopic features of early BSCCE are not well described. We herein report the endoscopic features and associated histology of an early BSCCE limited within the mucosal lamina propria (m2). To our knowledge, this is the earliest BSCCE reported to date. Case presentation A 62-year-old male patient was admitted to our hospital because of epigastric pain for 3 months. White light endoscopy revealed a flat lesion with mild sloping at the periphery. The lesion was covered with leukoplakia, and normal vascular network could not be seen in the lesion. Magnifying endoscopy with narrow-band imaging showed abnormal intra-papillary capillary loop categorized as type B1 according to the classification of the Japan Esophageal Society. Iodine staining revealed a less-stained lesion. The lesion was completely resected through endoscopic submucosal dissection. Histopathologically, tumor cells, which were limited within the mucosal lamina propria, formed solid nests and lobule structures, with ribbon-like arrangement of sparse cytoplasm and round to ovoid hyperchromatic nuclei. A final diagnosis of early BSCCE was established. Conclusions This is the earliest BSCCE reported to date. The prominent lesion with a gentle rising slope and less-staining or abnormal stain might be initial feature of early BSCCE.
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Affiliation(s)
- Lianjun Di
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China
| | - Kuang-I Fu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China.,Department of Endoscopy, Kanma Memorial Hospital, Tokyo, Japan
| | - Xinglong Wu
- Department of pathology, Affiliated Hospital, Zunyi Medical University, Zunyi, China
| | - Xuemei Liu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China
| | - Rui Xie
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China
| | - Rong Zhu
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China
| | - Biguang Tuo
- Department of Gastroenterology, Affiliated Hospital, Zunyi Medical University, Zunyi, 563003, China.
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12
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Kim SB, Lee SH, Jeong DE, Kim KO, Gu MJ. Esophageal Basaloid Squamous Carcinoma Treated by Endoscopic Resection and Radiation. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 72:258-261. [DOI: 10.4166/kjg.2018.72.5.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Sung Bum Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Si Hyung Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Da Eun Jeong
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Mi Jin Gu
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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13
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Maebayashi T, Ishibashi N, Aizawa T, Sakaguchi M, Taku H, Ohhara M, Takimoto T, Tanaka Y. A long-surviving patient with advanced esophageal basaloid squamous cell carcinoma treated only with radiotherapy: case report and literature review. BMC Gastroenterol 2017; 17:151. [PMID: 29216832 PMCID: PMC5721517 DOI: 10.1186/s12876-017-0714-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background Esophageal basaloid squamous cell carcinoma (EBSCC) is a rare malignant disease. Advanced EBSCC (AEBSCC) has a poorer prognosis than the more common esophageal squamous cell carcinoma, but no treatment policy has yet been established. This is the first reported case with AEBSCC treated only with radiotherapy. Thus, our long-surviving patient merits consideration. We therefore reviewed cases with the same stage of AEBSCC for further investigation. Case presentation An 85-year-old man with a chief complaint of difficulty swallowing foods was diagnosed with AEBSCC, cT3N1M0, stage III, by thorough examination. The basaloid carcinoma extended from the upper thoracic esophagus to the middle thoracic esophagus based on imaging studies, endoscopy and biopsy. Morphologically, the tumor was an elevated ulcerative area. We conducted radiotherapy to relieve symptoms, as the patient and his family refused aggressive treatment. He has remained alive without recurrence for 2 years, to date, after completing radiotherapy. Conclusions Basaloid carcinoma might be highly sensitive to radiotherapy. Thus, radiotherapy for local control might be beneficial for elderly patients with complications and those refusing aggressive treatment.
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Affiliation(s)
- Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Homma Taku
- Department of Human Pathology, Division of Pathology and Microbiology, Nihion University School of Medicine, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Moritaka Ohhara
- Department of Digestive Surgery, Kasukabe Medical Center, Kasukabe, Saitama, 344-8588, Japan
| | - Toshirou Takimoto
- Department of Pathology, Kasukabe Medical Center, Kasukabe, Saitama, 344-8588, Japan
| | - Yoshiaki Tanaka
- Department of Radiation Oncology, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, 212-0014, Japan
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14
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Oguma J, Ozawa S, Kazuno A, Nitta M, Ninomiya Y, Tomita S. Clinicopahological features of superficial basaloid squamous cell carcinoma of the esophagus. Dis Esophagus 2017; 30:1-5. [PMID: 28881881 DOI: 10.1093/dote/dox076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Indexed: 12/11/2022]
Abstract
Basaloid squamous cell carcinoma (BSC) of the esophagus is classified as an epithelial malignant tumor and is a rare variant of squamous cell carcinoma (SCC). Most previous reports have suggested that advanced BSC has a poorer prognosis than typical SCC because of its high biological malignancy, but the biological activity of superficial BSC remains unclear. Twenty cases of superficial BSC, which underwent surgical resection in Tokai University Hospital between January 2004 and December 2013, were analyzed retrospectively. Among these cases, 19 cases with a T1 depth of invasion (BSC group) were compared with 180 cases of SCC that were resected during the same period and were pathologically diagnosed as T1 (SCC group). The frequency of lymph node metastasis in the T1 BSC group was significantly lower (2 patients, 11%) than that in the SCC group (84 patients, 47%) (P = 0.005). The frequency of lymphatic invasion in the BSC group was also lower (9 patients, 47%) than that in the SCC group (131 patients, 73%) (P = 0.021). The pathological type of the metastatic lymph node was BSC in all the superficial BSC cases with lymph node metastasis. This study demonstrated that lymph node metastasis was less likely to occur in cases with superficial BSC than in cases with superficial SCC.
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Affiliation(s)
- J Oguma
- Departments of Gastroenterological Surgery
| | - S Ozawa
- Departments of Gastroenterological Surgery
| | - A Kazuno
- Departments of Gastroenterological Surgery
| | - M Nitta
- Departments of Gastroenterological Surgery
| | - Y Ninomiya
- Departments of Gastroenterological Surgery
| | - S Tomita
- Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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15
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Salami A, Abbas AE, Petrov R, Jhala N, Bakhos CT. Comparative Analysis of Clinical, Treatment, and Survival Characteristics of Basaloid and Squamous Cell Carcinoma of the Esophagus. J Am Coll Surg 2017; 226:1086-1092. [PMID: 29133264 DOI: 10.1016/j.jamcollsurg.2017.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Basaloid squamous cell carcinoma (BSC) is a rare variant of squamous cell carcinoma (SqCC) of the esophagus. Even though pathologically thought to be more aggressive than SqCC, there is discrepancy in the literature regarding the outcomes of BSC compared with those of SqCC. STUDY DESIGN We conducted a retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database. All patients with a histologic diagnosis of BSC and SqCC between 2004 and 2013 were included. We compared treatment and survival characteristics of patients with BSC and SqCC. RESULTS There were 16,158 patients included in this study; 173 patients (1.1%) had BSC. There were no significant differences between the 2 groups based on age, sex, marital status, insurance, or geographic region of diagnosis, but patients with BSC were more likely to be Caucasian (73.4% vs 64.7%; p = 0.017). Among staged patients, baseline tumor stage was similar in both groups. However, BSC tumors were more likely to be of high pathologic grade (56.8% vs 38.2%; p < 0.001). Patients with SqCC were more likely to receive radiation therapy (36.9% vs 53.9%; p < 0.001), while patients with BSC were more likely to undergo resection (32.4% vs 17.0%; p < 0.001). Median overall survival was similar in both groups (14 vs 9 months; log rank = 0.144), and this relationship persisted after stratification by treatment. CONCLUSIONS Even though more likely to be poorly differentiated at presentation, BSC of the esophagus seems to have similar clinical features and survival outcomes when compared with SqCC. Patients with BSC and SqCC should undergo stage-specific treatment to achieve optimal outcomes.
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Affiliation(s)
- Aitua Salami
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA
| | - Abbas E Abbas
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA
| | - Roman Petrov
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA
| | - Nirag Jhala
- Department of Pathology, Temple University Hospital, Philadelphia, PA
| | - Charles T Bakhos
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA; Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA.
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16
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Puri S, Holle LM, Forouhar FA, Clement JM. Subcutaneous metastasis from recurrent basaloid squamous cell carcinoma of the esophagus. J Oncol Pharm Pract 2017; 25:492-496. [DOI: 10.1177/1078155217736920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Esophageal cancer is the 11th most common cause of cancer mortality in the United States. It is aggressive in nature and has an ability to spread rapidly through direct extension, lymphatic spread, or hematogenously. With an estimated incidence of 1%, cutaneous metastases from esophageal cancer are extremely rare. Case presentation In this case study and review, we describe a case of recurrent esophageal basaloid squamous cell carcinoma presenting as multiple, rapidly progressing and tender subcutaneous nodules. A 69-year-old male with history of basaloid squamous cell carcinoma of the esophagus treated with concurrent chemoradiation, presented to his oncologist with complaints of a large, painful nodule at the nape of his neck approximately two years after completing treatment. On further examination, he was noted to have multiple, well circumscribed, solid, tender nodules on his abdominal wall along with a painful nodule on the pulp of his index finger. Histopathology from all sites revealed skin infiltration by high-grade invasive basaloid subtype of squamous cell carcinoma, similar to patient’s prior known and treated primary esophageal cancer. Further imaging work up showed extensive metastatic disease involving lung, liver, and brain. Conclusion Esophageal squamous cell carcinoma rarely metastasize to the skin. Subcutaneous nodules can be the first presentation of recurrent disease. The lesions are commonly confused with skin infections and treated inappropriately with antibiotics, leading to delay in diagnosis of recurrent disease. Early biopsy of suspicious lesions should be performed, especially in patients with history of cancer, such that prompt diagnosis and treatment can occur to maximize patient outcomes.
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Affiliation(s)
- Sonam Puri
- Department of Hematology and Oncology, H Lee Moffitt Cancer Center/University of South Florida, Tampa, FL, USA
| | - Lisa M Holle
- Department of Pharmacy Practice, UConn School of Pharmacy, Storrs, CT, USA
| | - Faripour A Forouhar
- Department of Pathology and Laboratory Medicine, UConn Health, Farmington, CT, USA
| | - Jessica M Clement
- Department of Hematology and Oncology, UConn Health, Farmington, CT, USA
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17
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Tada T, Honma R, Imai JI, Saze Z, Kogure M, Marubashi S, Tasaki K, Unakami M, Ezaki J, Tamura H, Nishikawa A, Hashimoto Y, Waguri S, Watanabe S, Gotoh M. A novel gene expression scoring system for accurate diagnosis of basaloid squamous cell carcinoma of the esophagus. Int J Oncol 2017; 51:877-886. [PMID: 28731134 DOI: 10.3892/ijo.2017.4075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 07/04/2017] [Indexed: 11/06/2022] Open
Abstract
Basaloid squamous cell carcinoma of the esophagus (BSCE) is a rare variant of squamous cell carcinoma that is difficult to distinguish from other carcinomas by preoperative endoscopic biopsy because of its histological varieties. Accurate diagnosis is essential for adequate treatment, and the methods proposed so far (e.g., immunohistochemical staining) have limitations. In this study, we tried to identify the characteristic bundles of gene expression in BSCE using comprehensive gene expression analysis (CGEA). Subsequently, we constructed a gene expression scoring system for the proper diagnosis of BSCE. Fifty-seven surgical specimens, including seven BSCEs, obtained from 30 patients who underwent esophagectomy were used for constructing the scoring system. Three hundred and twelve biopsy specimens, including eight BSCEs, obtained from 80 patients and 20 commercially available formalin-fixed paraffin-embedded (FFPE) specimens diagnosed as esophageal cancer, including 13 BSCEs, were used for validation. After our original mathematical extraction algorithm, 75 genes were extracted to distinguish BSCE from non-BSCE. The cumulative converted values (gene expression score) of the respective 75 genes from each specimen were obtained and lined up in ascending order to assess the optimal gene expression cut-off score for a definitive diagnosis of BSCE. The validation of this scoring system showed high prediction of the biopsy specimens [area under the curve (AUC)=0.981; 95% confidence interval (CI): 0.952‑1.000] and the commercially available FFPE specimens (AUC=0.901; 95% CI: 0.750-1.000). In conclusion, using CGEA in a gene expression scoring system helps in differentiating BSCE from non-BSCE with high accuracy and may contribute in improving BSCE treatment.
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Affiliation(s)
- Takeshi Tada
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Reiko Honma
- Nippon Gene Co., Ltd., Chiyoda, Tokyo 101-0054, Japan
| | - Jun-Ichi Imai
- Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Zenichiro Saze
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Michihiko Kogure
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Shigeru Marubashi
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Kazuhiro Tasaki
- Department of Diagnostic Pathology, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | | | - Junji Ezaki
- Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Hirosumi Tamura
- Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | | | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Satoshi Waguri
- Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Shinya Watanabe
- Translational Research Center, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
| | - Mitsukazu Gotoh
- Department of Regenerative Surgery, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
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18
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Xiao Q, Zhang B, Deng X, Wu J, Wang H, Wang Y, Wang W. The Preoperative Neutrophil-To-Lymphocyte Ratio Is a Novel Immune Parameter for the Prognosis of Esophageal Basaloid Squamous Cell Carcinoma. PLoS One 2016; 11:e0168299. [PMID: 27959959 PMCID: PMC5154570 DOI: 10.1371/journal.pone.0168299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/28/2016] [Indexed: 01/22/2023] Open
Abstract
Background The pretreatment neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of prognosis in various malignancies, but its predictive capacity in basaloid squamous cell carcinoma of the esophagus (BSCCE) remains unclear. We aim to determine the value of the inflammation-related factors, including the NLR, neutrophil-to-monocyte ratio (NMR), and albumin levels, in predicting BSCCE prognosis. Methods We retrospectively analyzed the records of 121 patients with pathologically diagnosed BSCCE that underwent a curative esophagectomy from January 2007 to December 2014. Univariate and multivariate analyses were used to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS). Results The preoperative NLR was correlated with the tumor length and NMR. In OS univariate analyses, a high NLR (>1.77), high NMR (>12.31), and low albumin (≤40.0 g/L) level were significantly associated with a poorer survival in BSCCE. The median OS was significantly greater in low NLR (≤1.77) than in the high NLR (>1.77) patients (51.0 vs. 31.0 months; P = 0.008). In multivariate analyses, only the NLR was an independent prognostic factor for OS (hazard ratio (HR), 2.030; 95% confidence interval (CI), 1.262–3.264; P = 0.003). A high NLR was also an independent predictor of a poorer RFS in BSCCE (HR, 2.222; 95% CI, 1.407–3.508; P = 0.001); the median RFS for low (≤1.77) and high (> 1.77) NLR patients was 44.0 months and 14.0 months, respectively. NLR remained a strong prognostic indicator for OS in stage I/II patients and a preoperative NLR>1.77 was predictive of a poor RFS in both stage I/II and stage III patients. Conclusions We show that the preoperative NLR, a convenient and cost-effective biomarker, may serve as a prognostic indicator for BSCCE patients following curative surgery.
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Affiliation(s)
- Qin Xiao
- Key Laboratory of Translational Radiation Oncology, Hunan Province, Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Baihua Zhang
- The 2nd Department of Thoracic Surgery, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Xiang Deng
- The 2nd Department of Thoracic Surgery, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Jie Wu
- The 2nd Department of Thoracic Surgery, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Hui Wang
- Key Laboratory of Translational Radiation Oncology, Hunan Province, Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
- * E-mail:
| | - Yonggang Wang
- Department of Thoracic Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenxiang Wang
- The 2nd Department of Thoracic Surgery, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
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19
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Tripathi M, Swanson PE. Rare tumors of esophageal squamous mucosa. Ann N Y Acad Sci 2016; 1381:122-132. [PMID: 27310830 DOI: 10.1111/nyas.13108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/22/2016] [Accepted: 04/27/2016] [Indexed: 12/15/2022]
Abstract
In spite of increasing incidence of esophageal adenocarcinoma in the last few decades, esophageal squamous cell carcinoma (SCC) still remains the dominant subtype of esophageal cancer worldwide. Apart from conventional SCC, some rare unconventional tumors of esophageal squamous mucosa are also well known. This study provides an introduction to these and presents a brief review of the literature, including the diagnostic and prognostic importance of each variant.
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Affiliation(s)
- Monika Tripathi
- Department of Histopathology, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom
| | - Paul E Swanson
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
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20
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Sato-Kuwabara Y, Fregnani JHTG, Jampietro J, Carvalho KC, Franco CP, da Costa WL, Coimbra FJF, Soares FA. Comparative analysis of basaloid and conventional squamous cell carcinomas of the esophagus: prognostic relevance of clinicopathological features and protein expression. Tumour Biol 2015; 37:6691-9. [PMID: 26649862 DOI: 10.1007/s13277-015-4551-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/30/2015] [Indexed: 12/01/2022] Open
Abstract
Basaloid squamous cell carcinoma (BSCC), a variant of squamous cell carcinoma (SCC), is a rare and aggressive epithelial malignancy which has been reported in only 0.1-11 % of primary esophageal carcinomas. In this study, a comparison of clinicopathological features and protein expression between esophageal BSCC (EBSCC) and conventional esophageal SCC (ESCC) cases from Brazil was performed in order to find factors that can be relevant to better characterize EBSCC. The expression of HER2, epidermal growth factor receptor (EGFR), Ki-67, and cyclins (A, B1, and D1) in 111 cases (95 ESCC and 16 EBSCC) was evaluated by immunohistochemistry using tissue microarray. When the clinicopathological data were compared, no significant difference was found between the two histological types. Although the difference is not significant (p = 0.055), the EGFR expression was more frequent in the conventional ESCC than in the EBSCC group. Our results indicate that the clinicopathological profiles of conventional ESCC and EBSCC are similar and provide no indicators for differences in prognosis between these two groups.
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Affiliation(s)
- Yukie Sato-Kuwabara
- International Research Center, A.C. Camargo Cancer Center, Rua Taguá, 440 Liberdade, São Paulo, SP, 01508-010, Brazil.
| | - José Humberto T G Fregnani
- Gynecologic Oncology Department, Fundação Pio XII, Hospital do Câncer de Barretos, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14784-400, Brazil
| | - Juliano Jampietro
- International Research Center, A.C. Camargo Cancer Center, Rua Taguá, 440 Liberdade, São Paulo, SP, 01508-010, Brazil
| | - Katia Cândido Carvalho
- Obstetrics and Gynecology Department, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455, São Paulo, SP, 01246-903, Brazil
| | - Carolina Parucce Franco
- Department of Abdominal Surgery, A.C. Camargo Cancer Center, Rua Antônio Prudente, 211, 1o. andar, São Paulo, SP, 01509-010, Brazil
| | - Wilson Luís da Costa
- Department of Abdominal Surgery, A.C. Camargo Cancer Center, Rua Antônio Prudente, 211, 1o. andar, São Paulo, SP, 01509-010, Brazil
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, A.C. Camargo Cancer Center, Rua Antônio Prudente, 211, 1o. andar, São Paulo, SP, 01509-010, Brazil
| | - Fernando Augusto Soares
- Department of Anatomic Pathology, A.C. Camargo Cancer Center, Rua Antônio Prudente, 211, 1o. andar, São Paulo, SP, 01509-010, Brazil.,Department of Stomatology, School of Dentistry, University of São Paulo, Av. Professor Lineu Prestes, 2227, São Paulo, SP, 05508-000, Brazil
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Ishida H, Nakano T, Fujishima F, Kamei T, Taniyama Y, Sakurai T, Sato C, Fukutomi T, Kamiya K, Ozawa Y, Sasano H, Ohuchi N. Surgical resection and chemoradiotherapy for metachronous pulmonary metastasis of basaloid squamous cell carcinoma of the oesophagus. Int J Surg Case Rep 2015; 17:151-4. [PMID: 26629851 PMCID: PMC4701867 DOI: 10.1016/j.ijscr.2015.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/13/2015] [Indexed: 12/09/2022] Open
Abstract
Basaloid squamous cell carcinoma of the oesophagus (BSCCE) is a rare entity. A recurrent lesion was observed after resection of the pulmonary BSCCE metastasis. Pulmonary metastasis of BSCCE after lung metastasectomy was treated successfully with chemoradiotherapy.
Introduction Basaloid squamous cell carcinoma of the oesophagus (BSCCE) is a relatively rare variant of oesophageal malignancy. There are no established treatment strategies for pulmonary metastases of BSCCE. Presentation of case A 72-year-old man underwent oesophagectomy and subsequently received a pathological diagnosis of stage IIIA (T3N1M0) BSCCE according to Union for International Cancer Control. One year and 5 months later, he underwent partial resection of the right lung because of metastasis of the BSCCE. One year and 6 months after the pulmonary resection, recurrence in the right lung was observed. The patient was treated with concurrent chemoradiotherapy using cisplatin and 5-fluorouracil, and the lesion completely disappeared. The patient is doing well without recurrence 5 years after chemoradiotherapy. Discussion In our case, the recurrent lesion in the right lung was observed after the pulmonary resection. It is difficult to determine whether the recurrent lesion is solitary or multiple and whether it is a local or pleural metastasis. Therefore, surgical indication must be decided carefully. Systemic chemotherapy or radiotherapy is useful to treat BSCCE metastasis, however, appropriate, but which agents and their regimens are appropriate is not clear. Concurrent chemotherapy using cisplatin and 5-fluorouracil and radiotherapy for pulmonary BSCCE metastases may provide curative therapy and should be considered. Conclusion This report describes a case of recurrent pulmonary metastasis after pulmonary resection of BSCCE metastasis, successfully treated by concurrent chemotherapy and radiotherapy. Further studies are required to establish the indications and efficacy of these therapeutic approaches.
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Affiliation(s)
- Hirotaka Ishida
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Toru Nakano
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan.
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Takashi Kamei
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Yusuke Taniyama
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Tadashi Sakurai
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Chiaki Sato
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Toshiaki Fukutomi
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Kuroudo Kamiya
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Yohei Ozawa
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
| | - Noriaki Ohuchi
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan
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Xing YL, Wang YC. Influence of autologous and homologous blood transfusion on interleukins and tumor necrosis factor-α in peri-operative patients with esophageal cancer. Asian Pac J Cancer Prev 2015; 15:7831-4. [PMID: 25292072 DOI: 10.7314/apjcp.2014.15.18.7831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To explore the influence of different ways of blood transfusion on the expression levels of interleukins (IL) and tumor necrosis factor-α (TNF-α) inperi-operative patients with esophageal cancer. MATERIALS AND METHODS A total of 80 patients with esophageal cancer who underwent radical operations were selected as study patients and randomly divided into an observation group (treated with autologous blood transfusion) and control group (with homologous blood transfusion). Changes of intra-operative indexes and peri-operative blood indexes, from hemoglobin (Hb) and hematocrit value (Hct), to levels of inflammatory factors like interleukins-6 (IL-6), IL-8, IL-10 and tumor necrosis factor-α (TNF-α) were compared. RESULTS Operations for patients in both groups were successfully conducted, and no significant differences in mean surgical duration and intra-operative hemorrhage volume, fluid infusion volume and blood transfusion volume were detected (p>0.05). Compared with values before surgery, Hb and Hct levels decreased significantly while white blood cell count (WBC) increased 1, 5 and 7 d after operation (p<0.05, p<0.01). In addition, WBC was apparently higher in observation group than in control group 5 and 7 d after operation (p<0.01). Compared with before surgery, in the observation group, levels of IL-6, IL-8 and IL-10 had no significant differences after operation (P>0.05), but TNF-α level increased y (p<0.01), whereas in control group, IL-6 level had no significant difference (p>0.05), IL-8 level decreased obviously (p<0.05), IL-10 level increased markedly first and then decreased gradually as time passed but its level remained elevated (p<0.01), and TNF-α level increased first and then decreased, and there was no significant difference 7 d after operation (p>0.05). CONCLUSIONS Decreased IL-8 and increased IL-10 levels are two important reasons forimmunosuppression after homologous blood transfusion, whereas autologous blood transfusion can alleviate this while increasing the TNF-α level, which also has potential to improve anti-tumor immunity in the human body.
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Affiliation(s)
- Yue-Li Xing
- Department of Blood Transfusion, Binzhou Medical University Hospital, Binzhou, China E-mail :
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Peng ZM, Yu W, Xie Y, Peng WH, Cao HH, Shen JH, Wu ZY, Li EM, Xu LY. A four actin-binding protein signature model for poor prognosis of patients with esophageal squamous cell carcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:5950-9. [PMID: 25337239 PMCID: PMC4203210 DOI: pmid/25337239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/20/2014] [Indexed: 02/05/2023]
Abstract
The actin cytoskeleton is a dynamic structure with actin-binding proteins (ABPs) playing an essential role in the regulation of migration, differentiation and signal transduction in all eukaryotic cells. We examined the relationship between altered expression of four ABPs and clinical parameters in esophageal squamous cell carcinoma (ESCC). To this end, we analyzed 152 formalin-fixed and paraffin-embedded esophageal curative resection specimens by immunohistochemistry for tensin, profilin-1, villin-1 and talin. A molecular predictor model, based on the combined expression of the four proteins, was developed to correlate the expression pattern of the four ABPs with clinical factors and prognosis of ESCC. According to the results, weak significance was found for tensin in lymph node metastasis (P=0.033), and profilin-1 in pTNM stage (P=0.031). However, our four-protein model showed strong correlation with the 5-year overall survival rate (P=0.002). Similarly, Kendall's tau-b test also showed the relationship between the collective expression pattern of the four ABPs with lymph node metastasis (P=0.005) and pTNM stage (P=0.001). Our results demonstrate that the collective protein expression pattern of four actin-binding proteins could be a biomarker to estimate the prognosis of ESCC patients.
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Affiliation(s)
- Zhang-Mei Peng
- Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou University Medical CollegeShantou 515041, P. R. China
- Institute of Oncologic Pathology, Shantou University Medical CollegeShantou 515041, P. R. China
| | - Wei Yu
- Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou University Medical CollegeShantou 515041, P. R. China
- Institute of Oncologic Pathology, Shantou University Medical CollegeShantou 515041, P. R. China
| | - Ying Xie
- Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou University Medical CollegeShantou 515041, P. R. China
- Institute of Oncologic Pathology, Shantou University Medical CollegeShantou 515041, P. R. China
| | - Wei-Hua Peng
- Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou University Medical CollegeShantou 515041, P. R. China
- Institute of Oncologic Pathology, Shantou University Medical CollegeShantou 515041, P. R. China
| | - Hui-Hui Cao
- Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou University Medical CollegeShantou 515041, P. R. China
- Institute of Oncologic Pathology, Shantou University Medical CollegeShantou 515041, P. R. China
| | - Jin-Hui Shen
- Department of Pathology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen UniversityShantou 515041, P. R. China
| | - Zhi-Yong Wu
- Department of Oncologic Surgery, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen UniversityShantou 515041, P. R. China
| | - En-Min Li
- Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou University Medical CollegeShantou 515041, P. R. China
- Department of Biochemistry and Molecular Biology, Shantou University Medical CollegeShantou 515041, P. R. China
| | - Li-Yan Xu
- Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou University Medical CollegeShantou 515041, P. R. China
- Institute of Oncologic Pathology, Shantou University Medical CollegeShantou 515041, P. R. China
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