Cases Of Esophageal Carcinoma Research Articles

A Case of Superficial Esophageal Neuroendocrine Carcinoma with Marked Morphological Changes in a Short Period.

A de novo whitish subepithelial lesion (SEL) with irregular vascular hyperplasia was detected in the lower thoracic esophagus during endoscopic surveillance. Special types of esophageal cancer were suspected; however, endoscopic biopsy specimens were inadequate for a diagnosis. Ten days later, endoscopic ultrasound showed a 7-mm homogeneously hypoechoic round mass in the submucosa, and a biopsy confirmed a histological diagnosis of esophageal neuroendocrine carcinoma (eNEC). Based on the clinical diagnosis of cT2N0M0, subtotal esophagectomy followed by adjuvant chemotherapy was performed immediately after endoscopic reexamination revealing a 20-mm reddish SMT. We herein report the marked changes in endoscopic findings of eNEC within 1.5 months.

A case of esophageal squamous cell carcinoma with epidermization showing a unique morphology.

An 80-year-old woman with a history of endoscopic balloon dilation for esophageal stricture caused by accidental ingestion of caustic soda during infancy presented with dysphagia. Upper gastrointestinal endoscopy revealed a 10-cm-long, highly white, elevated lesion with a feathered appearance. This lesion was determined to be the cause of dysphagia and was completely resected via endoscopic submucosal dissection. Histopathological examination revealed a thick keratin layer on the surface of the stratified squamous epithelium, with a prominent granular layer underneath and some areas showing nuclear atypia. The lesion was diagnosed as a well-differentiated squamous cell carcinoma, pT1a-LPM, derived from epidermoid metaplasia. Cancer genome analysis revealed mutations in TP53 as well as amplification of MYC, FGFR1, chromosome 7, and chromosome 20q. This case suggests that epidermoid metaplasia caused by chronic irritation from an esophageal stricture may have been exacerbated by the dilation procedure.

347. THE EFFICACY OF CONVERSION SURGERY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH INVASION OF OTHER ORGANS

Abstract Background There are cases of advanced unresectable esophageal squamous cell carcinoma (ESCC) with invasion of other organs that can be successfully treated with chemoradiotherapy and systemic chemotherapy, enabling surgical resection. We actively perform conversion surgery for ESCC with invasion of other organs after definitive chemoradiotherapy or systemic chemotherapy. Methods The patients who underwent conversion therapy in our hospital for ESCC between 2012 and 2022 at participating institutions were retrospectively reviewed. We evaluated patient backgrounds, treatment outcomes, and overall survival (OS) were evaluated. 31 patients were enrolled. 14 conversion cases were performed after chemoradiotherapy, 17 cases were after chemotherapy. All 17 patients received systemic chemotherapy with DCF (Docetaxel + Cisplatin + 5-FU), and all 14 definitive chemoradiotherapy was administered at least 50 Gy. Results There were 24 males and 7 females with a median age of 67 (47-75) years. Involved organs were trachea in 24 cases, aorta in 6 cases, and pulmonary vein in 1 case. 19 patients underwent open esophagectomy, 11 thoracoscopic, and 1 robot-assisted. 14 patients had complications of Clavien-Dindo grade 3, mainly pneumonia, leakage, and recurrent laryngeal nerve palsy. 22 (71%) were performed R0 resection. Recurrence was observed in 20 patients (65%). Overall, 3-year PFS was 22% and 3-year OS was 39%. 3-year OS in patients with R0 resection was 49% while 12.5% in patients with R1 and 2 resection. Conclusion This study showed that conversion therapy could be relatively safely for ESCC patients with organ invasion responded to initial chemotherapy and chemoradiotherapy. Especially in cases R0 resection was performed, good prognosis was obtained.

510. INNOVATIVE ROBOTIC-ASSISTED ESOPHAGECTOMY WITH THREE-FIELD LYMPHADENECTOMY: A NOVEL APPROACH TO ESOPHAGEAL CANCER SURGERY

Abstract Background Esophageal squamous cell carcinoma, the predominant form of esophageal cancer in Thailand, often presents at advanced stages (III - IV), necessitating surgical intervention. Radical esophagectomy, including three-field lymphadenectomy, stands as one of the most invasive gastrointestinal surgeries. However, in the era of minimally invasive surgery (MIS), robotic systems have emerged as a formidable approach to achieve radical treatment goals while minimizing surgical invasiveness. This video showcases a novel surgical technique and its challenges. Methods A case of mid-thoracic esophageal squamous cell carcinoma, clinically staged III, treated via robotic-assisted esophagectomy and three-field lymphadenectomy using the Da Vinci Xi system. The operation encompassed three phases: Initially, the thoracic phase with patient in semi-prone position with three robotic and one assistant trocars for complete esophageal mobilization and mediastinal lymph node retrieval. The abdominal phase, followed by the cervical phase, utilized four robotic trocars and one assistant trocar in supine position with hyperextended neck, facilitating perigastric lymph node retrieval, gastric tube reconstruction via the posterior mediastinal route, and cervical esophago-gastric tube anastomosis using a circular stapler. Results The patient experienced an uneventful recovery. Postoperative esophagogastroduodenoscopy on day 1 revealed the integrity of the anastomosis and normal vocal cord function. Imaging conducted on day 7 confirmed that the anastomosis was patent without any leakage. Surgical outcomes included an operative time of 615 minutes, estimated blood loss of 150 ml, a 14-day hospital stay, and recovery without complications. This video highlights the intricacies of the procedure and the robotic system's ability to access anatomically challenging spaces, thereby minimizing surgical invasiveness and enhancing recovery. Conclusion The robotic system is capable of performing radical procedures in anatomically challenging areas, such as narrow spaces and areas requiring precise maneuverability among vital structures. It enables a comprehensive approach spanning from the upper to the lower thoracic regions and diversity of surgery in thoracic and abdominal cavity. Additionally, this presentation highlights unique surgical tips and techniques that enhance the safety and feasibility of robotic-assisted esophagectomy. By significantly reducing surgical errors and optimizing outcomes for both oncologic and minimally invasive surgeries, it thereby marks a significant leap forward in the field of esophageal surgery. https://drive.google.com/file/d/1vrmu2D8TGoetnplcREPWQocXJle4PrOX/view?usp=share_link

Clinical pathological characteristics and expression of 328 proteins and their impact on survival in over 20,000 cases of esophageal squamous cell carcinoma and colorectal adenocarcinoma

Clinical pathological characteristics and expression of 328 proteins and their impact on survival in over 20,000 cases of esophageal squamous cell carcinoma and colorectal adenocarcinoma

The significance of CD4+ and CD8+ T lymphocyte infiltration in esophageal squamous cell carcinoma.

To investigate the relationship between the abundance of CD4+ and CD8+ T cells in the tumor microenvironment and the prognosis of patients with esophageal squamous cell carcinoma, and to analyze their correlation and explore its clinical value. In total, we enrolled 120 cases of esophageal squamous cell carcinoma diagnosed. The abundance of CD4+ and CD8+ T lymphocytes in the tissue specimens of esophageal cancer was examined by immunohistochemistry. We measured the correlation between the abundance of CD4+ and CD8+ T lymphocytes and the clinical and pathological characteristics and prognosis of esophageal squamous cell carcinoma. The tissue abundance of CD4+ T lymphocytes was closely related to tumor prognosis (P < 0.05). Similarly, there was a statistically significant relationship between the tissue abundance of CD8+ T lymphocytes and patients' prognosis (P < 0.05), indicating that a high abundance of CD8+ T lymphocytes predicts better prognosis in esophageal squamous cell carcinoma. Surprisingly, we found that a higher CD4+/CD8+ ratio predicted a better prognosis of esophageal squamous cell carcinoma. The tissue abundance of CD4+ and CD8+ T lymphocytes can serve as an important indicator for predicting the long-term survival of patients with esophageal squamous cell carcinoma. A high CD4+/CD8+ ratio may improve patients' prognosis through several pathways. The association of this ratio with clinical and pathological characteristics may explain the poor efficacy of immunotherapy in patients with esophageal cancer. These findings may help us find new targets for immunotherapy by exploring the immune microenvironment of esophageal squamous cell carcinoma.

Clinico-pathological study of esophageal mucoepidermoid carcinoma: a 10-year survival from a single center

BackgroundMucoepidermoid Carcinoma of the Esophagus (MECE) is a relatively rare tumor type, with most of the current data derived from case reports or small sample studies. This retrospective study reports on the 10-year survival data and detailed clinicopathological characteristics of 48 patients with esophageal MEC.MethodsData were collected from 48 patients who underwent curative surgery for esophageal MEC at the Fourth Hospital of Hebei Medical University between January 1, 2004, and December 31, 2020. These were compared with contemporaneous cases of Esophageal Squamous Cell Carcinoma (ESCC) and Esophageal Adenocarcinoma (EAC). Using the Kaplan-Meier method and multivariate Cox regression analysis, we investigated the clinicopathological factors affecting the survival of patients with MEC.ResultsThe incidence of MECE was predominantly higher in males, with a male-to-female ratio of approximately 7:1. The mid-thoracic segment emerged as the most common site of occurrence. A mere 6.3% of cases were correctly diagnosed preoperatively. The lymph node metastasis rate stood at 35.4%. The overall 1-year, 3-year, 5-year, and 10-year survival rates for all patients were 85.4%, 52.1%, 37.0%, and 31.0%, respectively. Post 1:1 propensity score matching, no significant statistical difference was observed in the Overall Survival (OS) between MEC patients and those with Esophageal Squamous Cell Carcinoma (ESCC) and Esophageal Adenocarcinoma (EAC) (P = 0.119, P = 0.669). Univariate analysis indicated that T staging and N staging were the primary factors influencing the prognosis of esophageal MEC.ConclusionsMECE occurs more frequently in males than females, with the mid-thoracic segment being the most common site of occurrence. The rate of accurate preoperative endoscopic diagnosis is low. The characteristic of having a short lesion length yet exhibiting significant extramural invasion may be a crucial clinicopathological feature of MECE. The OS of patients with MEC does not appear to significantly differ from those with esophageal squamous carcinoma and adenocarcinoma.

Clinicopathological and molecular characteristics of esophageal carcinoma with ductal differentiation: analysis of 17 cases

Objective: To investigate the clinicopathological features and molecular genetic characteristics of esophageal carcinoma with ductal differentiation, and to summarize the experiences in its diagnosis and treatment. Methods: A total of 17 cases of esophageal carcinoma with ductal differentiation diagnosed in Ningbo Clinical Pathological Diagnosis Center, Ningbo, China from June 2011 to December 2022 were collected. The clinical information and pathological diagnosis was reviewed. The tumor histological features and immunohistochemical results were analyzed. The next-generation sequencing was performed to detect and analyze the gene mutations in tumor samples. Results: The 17 patients included in this study were 54-77 years old, with a median age of 66 years. There were 16 males and 1 female. Among them, 9 cases were mainly carcinoma with ductal differentiation. The squamous epithelium on the tumor's surface was accompanied by high-grade intraepithelial neoplasia. The tumor and atypical squamous epithelium were transitional, and the focus was accompanied by various proportions of squamous cell carcinoma component (less than 10%). The other 8 cases were mostly squamous cell carcinoma, basaloid squamous cell carcinoma or sarcomatoid carcinoma with various degrees of tumor specific differentiation and focal area of carcinoma with ductal differentiation (less than 10%). The tumor cells in the area with ductal differentiation were mainly arranged in small tubes, while the tubes showed a double-layer structure, including the inner cells and outer cells of the lumen. Immunohistochemical results showed that the outer cells of the tumorous tubules expressed p63, p40, CK5/6 and CK34βE12, while the inner cells expressed CK7. Compared with esophageal squamous cell carcinoma reported in the literature, the frequency of gene mutations such as MYC (P=0.002), TP63 (P=0.002), CDKN1C (P=0.002) and NFE2L2 (P=0.045) was significantly lower in this group of cases. At the signaling pathway level, the mutation frequency of NOTCH signaling pathway (P=0.041) was significantly higher, while the mutation frequencies of NRF2 pathway (P=0.013) and PI3K pathway (P=0.009) were significantly lower than that of esophageal squamous cell carcinoma. Conclusion: Esophageal carcinoma with ductal differentiation is a type of esophageal carcinoma with unique morphology, and its molecular changes are also significantly different from those of conventional esophageal squamous cell carcinoma.

An esophageal neuroendocrine tumor with initial present dysphagia: A case report

Introduction: Neuroendocrine Neoplasms (NENs) of the esophagus are exceedingly rare, representing 1.3% of gastrointestinall NENs and 0.4%-2% of all esophageal malignancies. Esophageal NENs are classified into well-differentiated Neuroendocrine Tumors (NETs) and poorly differentiated Neuroendocrine Carcinomas (NECs). Esophageal NETs commonly present with dysphagia, weight loss, and appetite loss. Case report: A 70-year-old male with a history of GERD presented with progressive dysphagia and weight loss. Endoscopy revealed an ulcerative lesion, which was confirmed to be a small cell neuroendocrine carcinoma through biopsy and immunohistochemistry. A PET scan indicated a stage III tumor with locoregional lymph node involvement. The patient initiated chemotherapy and, symptomatic improvement was reported after two cycles. Conclusion: We present a case of esophageal Small Cell Neuroendocrine Carcinoma (SCNEC) characterized by initial symptoms of dysphagia and weight loss. Given the rarity of this malignancy and the absence of a well-established standard treatment and staging system for Neuroendocrine Carcinomas (NECs), the management of patients and prediction of patient prognosis pose considerable challenges.

Study on the effect of different durations of decalcification and depigmentation on programmed death ligand 1 immunohistochemical staining.

Programmed death ligand 1 (PD-L1) score is an important companion diagnosis to predict the response to immunotherapy. Immunohistochemistry can accurately assess the expression of PD-L1 in routine paraffin-embedded tissue. However, whether decalcified or depigmented tissue is still accurate and can be used as a companion diagnosis is controversial. This study attempts to resolve this controversy by analyzing the effects of decalcification and depigmentation at different times on PD-L1 expression. Placental tissues were selected for tissue microarray, decalcification was performed according to time gradients of 6, 12, 24, 36, and 48 h, and depigmentation was performed according to time gradients of 1, 5, 15, 30, and 60 min. The intensity of PD-L1 expression at different time points was observed and quantified. Ten PD-L1-positive esophageal squamous carcinoma samples were selected for decalcification treatment, and the PD-L1. Combined Positive Score (CPS), Tumor Proportion Score (TPS) and Immunocyte Proportion Score (IPS) and the positivity rates were compared before and after decalcification. After the placenta was decalcified, the intensity of PD-L1 positivity diminished, and the average optical density (AOD) value decreased with the prolongation of decalcification time and decreased significantly (P<0.05) at 24 h compared with the control group, and significantly (P<0.01) at 36 and 48 h compared with the control group. The intensity of PD-L1 positivity was weakened considerably after the treatment with potassium permanganate depigmentation. In addition, the AOD value decreased significantly (P<0.01) after the depigmentation time reached 5 min compared with the control group. Ten cases of PD-L1 positive esophageal squamous carcinoma were treated with 24 h decalcification, although the PD-L1 score decreased to a certain degree (P>0.05), and the positivity rate could reach 90%. After 36 h treatment, PD-L1 scores decreased, the CPS and IPS scores decreased significantly (P<0.05), and the positive rate was only 50%. Potassium permanganate depigmentation significantly reduces PD-L1 expression, even for a shorter time, affecting the accuracy of the results. The accuracy of PD-L1 remained high within 24 h decalcification. The above results have certain reference value for clinical selection of immunotherapy.

Concordance of assessments of four PD-L1 immunohistochemical assays in esophageal squamous cell carcinoma (ESCC)

ObjectiveGiven real-world limitations in programmed death-ligand 1 (PD-L1) testing, concordance studies between PD-L1 assays are needed. We undertook comparisons of PD-L1 assays (DAKO22C3, Ventana SP263, Ventana SP142, E1L3N) among observers in esophageal squamous cell carcinoma (ESCC) to provide information on the analytical and clinical comparability of four PD-L1 IHC assays.MethodsParaffin embedded samples of 50 cases of esophageal squamous cell carcinoma were obtained, satined with all four PD-L1 assays. PD-L1 was evaluated by 68 pathologists from 19 different hospitals. PD-L1 expression was assessed for combined positive score (CPS).ResultsThe expression sensitivity of SP263 was the highest in ESCC, followed by 22C3, E1L3N and SP142. Taking CPS 10 as the critical value, inter-observer concordance for CPS scores among 68 physicians was assessed for the 22C3, SP263, SP142, and E1L3N assays, yielding values of 0.777, 0.790, 0.758, and 0.782, respectively. In the comparison between assays, the overall CPS scores concordance rates between 22C3 and SP263, SP142, and E1L3N were 0.896, 0.833, and 0.853, respectively. 22C3 and SP263 have high concordance, with OPA of 0.896, while E1L3N and SP142 have the highest concordance, with OPA of 0.908.ConclusionIn ESCC, the concordance of PD-L1 evaluation among observers is good, and the immune cell score is still an important factor affecting the concordance of interpretation among observers. Cases near the specific threshold are still the difficult problem of interpretation. SP263 had the highest CPS score of the four assays. SP263 cannot identify all 22C3 positive cases, but had good concordance with 22C3.E1L3N and SP142 showed high concordance.

RASSF1A promotes ATM signaling and RASSF1A methylation is a synthetic lethal marker for ATR inhibitors.

Aim: The mechanism of RASSF1A in DNA damage repair remains to be further clarified for applying to synthetic lethal strategy. Materials & methods: Eight esophageal cancer cell lines, 181 cases of esophageal dysplasia and 1066 cases of primary esophageal squamous cell carcinoma (ESCC) were employed. Methylation-specific PCR, theCRISPR/Cas9 technique, immunoprecipitation assay and a xenograft mouse model were used. Results: RASSF1A was methylated in 2.21% of esophageal dysplasia and 11.73% of ESCC. RASSF1A was alsoinvolved in DNA damage repair through activating Hippo signaling. Loss of RASSF1A expression sensitized esophageal cancer cell lines to ataxia telangiectasia mutated and rad3-related (ATR) inhibitor (VE-822) both in vitro and in vivo. Conclusion: RASSF1A methylation is a synthetic lethal marker for ATR inhibitors.

Three-staged minimally invasive esophagectomy with end-to-end esophago-gastric anastomosis for thoracic esophageal cancers: An experience from a low middle-income country

BackgroundEsophageal cancer is on a steady rise and carries significant mortality and morbidity. Depending upon the clinical stage at presentation, either chemotherapy, radiotherapy with or without surgical resection is the treatments in practice. Traditionally, open esophagectomy was performed but over time, the importance of minimally invasive esophagectomy has been established. In this study, we aimed to report our data of totally minimally invasive esophagectomies performed for thoracic esophageal cancers in last four years. MethodologyA prospective cross-sectional study was conducted at the Department of Upper GI Surgery, Dow University of Health Sciences, Karachi. All diagnosed cases of esophageal carcinoma undergoing minimally invasive esophagectomy, from 2019 to 2022 were included in this study. Outcomes measured were operative time, intra operative complications, conversion rate to open, postoperative complications, number of lymph nodes harvested, margin clearance, in-hospital mortality and 90-days mortality. ResultsA total of 53 cases were included in the study, the most prevalent histological type was squamous cell carcinoma 42(79.2%) as compared to adenocarcinoma 8(15.1%). Most common tumor site was lower thoracic esophagus (30–38 cm) in 20 (56.6%) cases. Neo-adjuvant chemotherapy was given in all 53(100%) cases, whereas neo-adjuvant radiation therapy was offered to 49(92.5%) patients. There was a significant and favorable patient response to the neo-adjuvant treatment in 37(69.8%) cases, leading to a decrease in tumor size. Laparoscopic McKeown Esophagectomies were performed in 44 (83.0%) and 9(17.0%) were Robot-assisted Minimally Invasive esophagectomy (RAMIE). Intraoperative injuries (i.e., lung parenchymal injury and bleeding) were reported in only 2(3.8%) patients. Post-operative complications were recorded in 12(22.6%) patients. Margin clearance was observed in 53 (100%) of the patients. The 90-day mortality rate was 3(5.7%), one due to bleeding and other two mortalities were due to COVID related respiratory complications. ConclusionMinimally invasive esophagectomy was found to be safe and feasible technique with encouraging results in terms of decreased intraoperative and post operative complications as well as achieving the standard oncological surgery with acceptable lymph node yield and margin clearance and in hospital and 90 days mortality.

A case of rare early type 0-IIb esophageal adenoid cystic carcinoma accompanied by squamous cell carcinoma

A case of rare early type 0-IIb esophageal adenoid cystic carcinoma accompanied by squamous cell carcinoma

M6A reading protein RBMX as a biomarker for prognosis and tumor progression in esophageal cancer.

As a member of m6A methylated binding protein, RNA binding motif protein X-linked (RBMX) has been reported to be associated with tumor invasion, metastasis and prognosis. However, the prognostic significance of RBMX expression in esophageal cancer (ESCA) remains unclear. Based on the TIMER database, GEPIA database, cBioPortal database, CIBERSORT deconvolution algorithm, String-DB database, LinkedOmics database, etc., the RBMX expression level, mRNA expression level, prognostic relationship, genetic mutation, immune cell infiltration level, protein interaction network, differential co-expression genes and functional enrichment in esophageal carcinoma were analyzed. Immunohistochemistry was used to detect the expression of RBMX in 53 cases of esophageal carcinoma and adjacent esophageal tissues. The RBMX expression in ESCA tissue was significantly higher than that in the normal tissues. The overall survival (OS) of patients with high RBMX expression was significantly lower than that of patients with low expression (P=0.04). The protein encoded by the RBMX gene appeared to copy number amplification, mutation and deep deletion. The expression level of RBMX was positively correlated with the levels of follicular helper T cells, eosinophils and initial B cells (P<0.05). Genes significantly and positively correlated with RBMX expression included HNRNPA1L2, SFRS13A, HNRNPA1, etc., which were mainly enriched in biological processes (BPs) such as cell division, mRNA splicing, RNA binding and mRNA 3'-UTR binding. RBMX may be as a biomarker of poor prognosis of ESCA. RBMX is closely related to the survival and prognosis, genetic mutation and immune cell infiltration of patients with ESCA.

27. OPLAH PROTEIN EXPRESSION STRATIFIES THE PROGNOSIS OF PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS

Abstract Background Squamous cell carcinoma (SCC) is one of the major subtypes of esophageal carcinoma, and accounts for up to 90% of esophageal carcinoma cases in eastern Asia and eastern and southern Africa and 50% in Western countries. The 5-year overall survival rate of ESCC patients who undergo curative treatment remains below 40%. The elucidation of molecular biomarkers could be of clinical importance both as prognostic factors besides the established clinical staging and as potential targets for treatment. We aimed to detect and validate the prognosticators of esophageal squamous cell carcinoma in patients who underwent radical esophagectomy. Methods We identified OPLAH as one of the differentially expressed genes between esophageal squamous cell carcinoma (ESCC) tissue and normal esophageal mucosa whose expression changes were significantly associated with a patient prognosis using The Cancer Genome Atlas data. The OPLAH protein expression in ESCC tissue and serum OPLAH protein concentrations were evaluated and analyzed for their association with clinicopathological factors. Results OPLAH mRNA was significantly overexpressed in ESCC tissue compared to normal esophageal mucosa, and patients with high OPLAH mRNA expression had a significantly poorer prognosis according to The Cancer Genome Atlas data. The high staining intensity of OPLAH protein in ESCC tissue clearly stratified patient prognosis. According to the multivariable analysis, high OPLAH protein expression was an independent prognostic factor for survival after surgery. Pre-neoadjuvant chemotherapy serum OPLAH protein concentrations were significantly associated with clinical tumor depth and node positivity and, consequently, with advanced clinical stage. The serum OPLAH protein concentration was significantly decreased by neoadjuvant chemotherapy. Conclusions OPLAH may serve as a useful prognosticator for ESCC patients.

Clinicopathological features of esophageal carcinoma with ductal differentiation of esophageal gland

Objective: To investigate the clinicopathological characteristics of esophageal carcinoma with gland duct differentiation. Methods: The clinical, morphologic and immunohistochemical (IHC) features of eight cases of esophageal carcinoma with gland duct differentiation diagnosed from 2012 to 2022 at the First Affiliated Hospital of Soochow University were summarized. Results: There were four males and four females, with a mean age of 68.5 (range 59-82) years. Two tumors were located in middle esophagus, five in the lower esophagus, and one in the cardia. The mean diameter was 2.4 cm (range 0.6-4.5 cm). The tumor had a bilayer epithelial structure, including the inner luminal epithelium and the outer basal epithelium. Immunohistochemistry showed that CK7 (8/8) and CK18 (8/8) were positive in the inner epithelium. p40 (8/8), p63 (8/8) and CK5/6 (8/8) were positive in the outer epithelium. SMA, calponin and CD117 were all negative. p53 mutants were found in all eight cases (strong and diffuse positivity in 6/8; complete loss of expression in 2/8). No columnar metaplasia, intestinal metaplasia and ectopic gastric mucosa were observed in the surface squamous epithelium in the cases. The mean follow-up time was 21.5 months (range 5-51 months). Seven patients survived and one patient died 31 months after surgery due to recurrence and liver metastasis. Conclusion: Esophageal carcinoma with esophageal gland duct differentiation is a rare tumor with unique histologic and IHC characteristics.

Esophageal carcinoma with SMARCA4 mutation: Unique diagnostic challenges

Esophageal carcinoma with SMARCA4 deficiency or dysfunction is a recently recognized entity. This study describes the clinicopathologic features of four cases of esophageal carcinoma with SMARCA4 mutation, three with deep deletion and one with missense mutation. Patients include 3 males and 1 female, with an age range of 45–68 years old. Histologically, the neoplasms showed frequent mitotic activity, large nucleus and prominent nucleoli. Glandular differentiation was variable from not identifiable to approximately 20% in the biopsy material. Percentage of rhabdoid morphology was also variable from not identifiable to 20% of the biopsy material. For these cases, one case was diagnosed SMARCA4 deficient esophageal carcinoma based on the biopsy of a retroperitoneal lymph node showing loss of BRG1 by immunostain, and next generation sequencing confirmed deep deletion of SMARCA4. The other three cases had diagnosis of undifferentiated carcinoma or poorly differentiated carcinoma, and the SMARCA4 deep deletion or mutation was discovered by next generation sequencing. Molecular analysis showed TP53 mutation in all the three cases with SMARCA4 deep deletion. Two of the patients deceased 72 and 78 days after diagnosis, and the other two patients showed limited or no treatment response to chemotherapy. In conclusion, esophageal carcinoma with SMARCA4 mutation may pose significant diagnostic challenge for surgical pathologists due to its variable morphology and immunoprofile, and accurate classification of this entity requires recognition of the spectrum of morphology and utilization of BRG1 immunostain and next generating sequencing.

DIAGNOSIS OF EPIDERMOID CARCINOMA OF THE TONGUE AFTER TREATMENT OF ESOPHAGUS EPIDERMOID CARCINOMA: A CASE REPORT

The present case report addresses the diagnosis and therapeutic process of a case of esophageal epidermoid carcinoma associated with a tongue second primary neoplasm. A 60-year-old Caucasian, male patient, smoker and drinker, diagnosed with stage III esophageal epidermoid carcinoma, treated with chemotherapy and radiotherapy with 50.4 Gy. By the end of radiotherapy, the patient was hospitalized with dysphagia and malnutrition. Under the initial complaint of oral pain, tooth mobility, thick bacterial plaque, and generalized calculus were identified, in addition to an approximately 1.3 cm ulcerated lesion on the right side of the tongue. Considering the lesion's clinical aspect and the patient´s history, an excisional biopsy was performed, where the histopathological analysis showed another manifestation of epidermoid carcinoma, causing the patient to be referred for treatment by the oncologist. Attention to clinical manifestations and the efficacy of the multidisciplinary team tends to provide a better prognosis for hospitalized patients. The present case report addresses the diagnosis and therapeutic process of a case of esophageal epidermoid carcinoma associated with a tongue second primary neoplasm. A 60-year-old Caucasian, male patient, smoker and drinker, diagnosed with stage III esophageal epidermoid carcinoma, treated with chemotherapy and radiotherapy with 50.4 Gy. By the end of radiotherapy, the patient was hospitalized with dysphagia and malnutrition. Under the initial complaint of oral pain, tooth mobility, thick bacterial plaque, and generalized calculus were identified, in addition to an approximately 1.3 cm ulcerated lesion on the right side of the tongue. Considering the lesion's clinical aspect and the patient´s history, an excisional biopsy was performed, where the histopathological analysis showed another manifestation of epidermoid carcinoma, causing the patient to be referred for treatment by the oncologist. Attention to clinical manifestations and the efficacy of the multidisciplinary team tends to provide a better prognosis for hospitalized patients.

Analysis of risk factors for depth of invasion and angiolymphatic invasion for circumferential superficial esophageal squamous cell carcinoma and precancerous lesion

Objective: To analyze clinicopathological features of circumferential superficial esophageal squamous cell carcinoma and precancerous lesions and investigate the risk factors for deep submucosal invasion and angiolymphatic invasion retrospectively. Methods: A total of 116 cases of esophageal squamous epithelial high-grade intraepithelial neoplasia or squamous cell carcinoma diagnosed by gastroscopy, biopsy pathology and endoscopic resection pathology during November 2013 to October 2021 were collected, and their clinicopathological features were analyzed. The independent risk factors of deep submucosal invasion and angiolymphatic invasion were analyzed by logistic regression model. Results: The multivariate logistic regression analysis showed that drinking history (OR=3.090, 95% CI: 1.165-8.200; P<0.05), The AB type of intrapapillary capillary loop (IPCL) (OR=11.215, 95% CI: 3.955-31.797; P<0.05) were the independent risk factors for the depth of invasion. The smoking history (OR=5.824, 95% CI: 1.704-19.899; P<0.05), the presence of avascular area (AVA) (OR=3.393, 95% CI: 1.285-12.072; P<0.05) were the independent factors for the angiolymphatic invasion. Conclusions: The risk of deep submucosal infiltration is greater for circumferential superficial esophageal squamous cell carcinoma patients with drinking history and IPCL type B2-B3 observed by magnifying endoscopy, while the risk of angiolymphatic invasion should be vigilant for circumferential superficial esophageal squamous cell carcinoma patients with smoking history and the presence of AVA observed by magnifying endoscopy. Ultrasound endoscopy combined with narrowband imagingand magnification endoscopy can improve the accuracy of preoperative assessment of the depth of infiltration of superficial squamous cell carcinoma and precancerous lesions and angiolymphaticinvasion in the whole perimeter of the esophagus, and help endoscopists to reasonably grasp the indications for endoscopic treatment.