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Oesophagus: Neoplastic Patterns and Mimics

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Endoscopic Biopsy Interpretation

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Abstract

One of the most common challenges confronted by pathologists in assessing esophageal biopsies is suspected esophageal neoplasia. This chapter elaborates the clinical setting leading to biopsy and provides the general approach to esophageal biopsy with emphasis on epithelial patterns. Common patterns of mesenchymal neoplasia are also touched on. The patterns of squamous and glandular dysplasia relevant for accurate and reproducible diagnosis are discussed in detail including features relevant to grading, identification of invasion, benign mimics, and diagnostic pitfalls. The key features are highlighted. Important concepts are further illustrated by short clinical stories that correlate important clinical, endoscopic, and pathologic features. Helpful diagnostic features are demonstrated and described with high-quality photomicrographs and accompanying descriptions.

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References

  1. Raftopoulos SC, Segarajasingam DS, Burke V, Ee HC, Yusoff IF. A cohort study of missed and new cancers after esophagogastroduodenoscopy. Am J Gastroenterol. 2010;105:1292–7.

    Article  PubMed  Google Scholar 

  2. Anonymous. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon:November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(6 Suppl):S3–43.

    Google Scholar 

  3. Cottreau J, Gruchy S, Kamionek M, Lauwers GY, Arnason T. Prevalence of oesophageal epidermoid metaplasia in 1048 consecutive patients and 58 patients with squamous neoplasms. Histopathology. 2016;68:988–95.

    Article  PubMed  Google Scholar 

  4. Singhi AD, Arnold CA, Crowder CD, Lam-Himlin DM, Voltaggio L, Montgomery EA. Oesophageal leukoplakia or epidermoid metaplasia: a clinicopathological study of 18 patients. Mod Pathol. 2014;27(1):38–43.

    Google Scholar 

  5. Dawsey SM, Lewin KJ, Wang GQ, Liu FS, Nieberg RK, Yu Y, et al. Squamous oesophageal histology and subsequent risk of squamous cell carcinoma of the esophagus.A prospective follow‐up study from Linxian, China. Cancer. 1994;74:1686–92.

    Google Scholar 

  6. Rubio C, Liu F, Zhao H. Histological classification of intraepithelial neoplasias and microinvasive squamous carcinoma of the esophagus. Am J Surg Pathol. 1989;13:685–90.

    Google Scholar 

  7. Taylor PR, Abnet CC, Dawsey SM. Squamous dysplasia - the precursor lesion for oesophageal squamouscarcinoma. Cancer Epidemiol Biomarkers Prev. 2013;22(4):540–52.

    Google Scholar 

  8. DiMaio MA, Kwok S, Montgomery KD, Lowe AW, Pai RK. Immunohistochemical panel for distinguishing oesophageal adenocarcinoma from squamous cell carcinoma: a combination of p63, cytokeratin 5/6, MUC5AC, and anterior gradient homolog 2 allows optimal subtyping. Hum Pathol. 2012;43(11):1799–807.

    Google Scholar 

  9. Wang HH, Zeroogian JM, Spechler SJ, Goyal RK, Antonioli DA. Prevalence and significance of pancreatic acinar metaplasia at the gastroesophageal junction. Am J Surg Pathol. 1996;20(12):1507–10.

    Article  CAS  PubMed  Google Scholar 

  10. Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.

    Article  PubMed  Google Scholar 

  11. Shaheen NJ, Falk GW, Iyer PG, Gerson L. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2015;108:1238–49.

    Google Scholar 

  12. Whiteman DC, Appleyard M, Bahin FF, Bobryshev YV, Bourke MJ, Brown I, et al. Australian clinical practice guidelines for the diagnosis and management of Barrett’s Esophagus and Early Oesophageal Adenocarcinoma. J Gastroenterol Hepatol. 2015;30:804–20.

    Google Scholar 

  13. Bennett C, Vakil N, Bergman J, Harrison R, Odze R, Vieth M, et al. Consensus statements for management of Barrett’s dysplasia and early-stage oesophageal adenocarcinoma, based on a delphi process. Gastroenterology. 2012;143(2):336–46.

    Google Scholar 

  14. Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Coco DP, Goldblum JR, Hornick JL, Lauwers GY, Montgomery E, Srivastava A, et al. Interobserver variability in the diagnosis of crypt dysplasia in Barrett esophagus. Am J Surg Pathol. 2011;35:45–54.

    Google Scholar 

  16. Curvers WL, ten Kate FJ, Krishnadath KK, Visser M, Elzer B, Baak LC, et al. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. Am J Gastroenterol. 2010;105:1523–30.

    Article  PubMed  Google Scholar 

  17. Skacel M, Petras RE, Rybicki LA, Gramlich TL, Richter JE, Falk GW, et al. p53 expression in low grade dysplasia in Barrett’s esophagus: correlation with interobserver agreement and disease progression. Am J Gastroenterol. 2002;97:2508–13.

    Article  CAS  PubMed  Google Scholar 

  18. Mahajan D, Bennett AE, Liu X, Bena J, Bronner MP. Grading of gastric foveolar-type dysplasia in Barrett’s esophagus. Mod Pathol. 2010;23:1–11.

    Article  PubMed  Google Scholar 

  19. Odze RD. Update on the diagnosis and treatment of barrett esophagus and related neoplastic precursor lesions. Arch Pathol Lab Med. 2008;132:1577–85.

    PubMed  Google Scholar 

  20. Goldblum JR. Current issues in Barrett’s esophagus and Barrett’s-related dysplasia. Mod Pathol. 2015;28(May 2014):S1–6.

    Article  PubMed  Google Scholar 

  21. Odze RD. Diagnosis and grading of dysplasia in Barrett’s oesophagus. J Clin Pathol. 2006;59:1029–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Odze RD. Barrett esophagus: histology and pathology for the clinician. Nat Rev Gastroenterol Hepatol. 2009;6:478–90.

    Article  PubMed  Google Scholar 

  23. Greenblatt MS, Bennett WP, Hollstein M, Greenblatt MS, Bennett WP, Hollstein M, et al. Mutations in the p53 tumour suppressor gene: clues to cancer etiology and molecular pathogenesis. Cancer Res. 1994;54:4855–78.

    Google Scholar 

  24. McCormick Matthews LH, Noble F, Tod J, Jaynes E, Harris S, Primrose JN, et al. Systematic review and meta-analysis of immunohistochemical prognostic biomarkers in resected oesophageal adenocarcinoma. Br J Cancer. 2015;113:107–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Brown IS, Whiteman DC, Lauwers GY. Foveolar type dysplasia in Barrett esophagus. Mod Pathol. 2010;23:834–43.

    Article  CAS  PubMed  Google Scholar 

  26. Park DY, Srivastava A, Kim GH, Mino-Kenudson M, Deshpande V, Zukerberg LR, et al. Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia. Am J Surg Pathol. 2008;32(4):524–33.

    Article  PubMed  Google Scholar 

  27. Patil DT, Bennett AE, Mahajan D, Bronner MP. Distinguishing Barrett gastric foveolar dysplasia from reactive cardiac mucosa in gastroesophageal reflux disease. Hum Pathol. 2013;44:1146–53.

    Article  PubMed  Google Scholar 

  28. Khor TS, Alfaro EE, Ooi EMM, Li Y, Srivastava A, Fujita H, et al. Divergent expression of MUC5AC, MUC6, MUC2, CD10, and CDX-2 in dysplasia and intramucosal adenocarcinomas with intestinal and foveolar morphology. Am J Surg Pathol. 2012;36(3):331–42.

    Article  PubMed  Google Scholar 

  29. Lomo LC, Blount PL, Sanchez CA, Li X, Galipeau PC, Cowan DS, et al. Crypt dysplasia with surface maturation. Am J Surg Pathol. 2006;30(4):423–35.

    Article  PubMed  Google Scholar 

  30. Younes M, Lauwers GY, Atilla E, Gulchin E, Verm R, Bridges M, et al. The significance of “‘indefinite for dysplasia’” grading in barrett metaplasia. Arch Pathol Lab Med. 2011;135:430–2.

    PubMed  Google Scholar 

  31. Sangle NA, Taylor SL, Emond MJ, Depot M, Overholt BF, Bronner MP. Overdiagnosis of high-grade dysplasia in Barrett’s esophagus: a multicenter, international study. Mod Pathol. 2015;28(6):758–65.

    Article  PubMed  Google Scholar 

  32. di Pietro M, Boerwinkel DF, Shariff MK, Liu X, Telakis E, Lao-Sirieix P, et al. The combination of autofluorescence endoscopy and molecular biomarkers is a novel diagnostic tool for dysplasia in Barrett’s oesophagus. Gut. 2015;64(1):49–56.

    Article  PubMed  Google Scholar 

  33. Ross-Innes CS, Becq J, Warren A, Cheetham RK, Northen H, O’Donovan M, et al. Whole-genome sequencing provides new insights into the clonal architecture of Barrett’s esophagus and oesophageal adenocarcinoma. Nat Genet. 2015;47:1038.

    Google Scholar 

  34. Stachler MD, Taylor-Weiner A, Peng S, McKenna A, Agoston AT, Odze RD, et al. Paired exome analysis of Barrett’s esophagus and adenocarcinoma. Nat Genet. 2015;47:1047–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Bhat S, Coleman HG, Yousef F, Johnston BT, McManus DT, Gavin AT, et al. Risk of malignant progression in Barrett’s Esophagus patients: results from a large population-based study. J Natl Cancer Inst. 2011;103:1049–57.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Prasad GA, Wang KK, Buttar NS, Wongkeesong L, Krishnadath KK, Nichols FC, et al. Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus. Gastroenterology. 2007;132:1226–33.

    Article  PubMed  Google Scholar 

  37. Mojtahed A, Shimoda T. Proper pathologic preparation and assessment of endoscopic mucosal resection and endoscopic submucosal dissection specimens. Tech Gastrointest Endosc. 2011;13:95–9.

    Article  Google Scholar 

  38. Kumarasinghe MP, Brown I, Raftopoulos S, Bourke MJ, Charlton A, de Boer WB, et al. Standardised reporting protocol for endoscopic resection for Barrett oesophagus associated neoplasia: expert consensus recommendations. Pathology. 2014;46:473–80.

    Article  CAS  PubMed  Google Scholar 

  39. Vieth M, Ell C, Gossner L, May A, Stolte M. Histological analysis of endoscopic resection specimens from 326 patients with Barrett’s esophagus and early neoplasia. Endoscopy. 2004;36:776–81.

    Article  CAS  PubMed  Google Scholar 

  40. Pennathur A, Farkas A, Krasinskas AM, Ferson PF, Gooding WE, Gibson MK, et al. Esophagectomy for T1 oesophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg. 2009;87:1048–55.

    Google Scholar 

  41. Patil DT, Goldblum JR, Rybicki L, Plesec TP, Mendelin JE, Bennett AE, et al. Prediction of adenocarcinoma in esophagectomy specimens based upon analysis of preresection biopsies of barrett esophagus with at least high-grade dysplasia: a comparison of 2 systems. Am J Surg Pathol. 2012;36:134–41.

    Article  PubMed  Google Scholar 

  42. Downs-Kelly E, Mendelin JE, Bennett AE, Castilla E, Henricks WH, Schoenfield L, et al. Poor interobserver agreement in the distinction of high-grade dysplasia and adenocarcinoma in pretreatment Barrett’s esophagus biopsies. Am J Gastroenterol. 2008;103:2333–40.

    Article  PubMed  Google Scholar 

  43. Zhu W, Appelman HD, Greenson JK, Ramsburgh SR, Orringer MB, Chang AC, et al. A histologically defined subset of high-grade dysplasia in Barrett mucosa is predictive of associated carcinoma. Am J Clin Pathol. 2009;132:94–100.

    Article  PubMed  Google Scholar 

  44. Abraham SC, Krasinskas AM, Correa AM, Hofstetter WL, Ajani JA, Swisher SG, et al. Duplication of the muscularis mucosae in Barrett esophagus: an underrecognized feature and its implication for staging of adenocarcinoma. Am J Surg Pathol. 2007;31:1719–25.

    Article  PubMed  Google Scholar 

  45. Lewis JT, Wang KK, Abraham SC. Muscularis mucosae duplication and the musculo-fibrous anomaly in endoscopic mucosal resections for barrett esophagus: implications for staging of adenocarcinoma. Am J Surg Pathol. 2008;32:566–71.

    Article  PubMed  Google Scholar 

  46. Hölscher AH, Vallböhmer D, Bollschweiler E. Early barrett’s carcinoma of the esophagus. Ann Thorac Cardiovasc Surg. 2008;14:347–54.

    PubMed  Google Scholar 

  47. Vieth M, Stolte M. Pathology of early upper GI cancers. Best Pract Res Clin Gastroenterol. 2005;19:857–69.

    Article  PubMed  Google Scholar 

  48. Orlowska J, Patchlewski J, Gugulski A, Butruk E. A conservative approach to granular cell tumours of the esophagus: four case reports and literature review. Am J Gastroenterol. 1993;88:311–5.

    Google Scholar 

  49. Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, Lordick F, Ohtsu A, Omuro Y, Satoh T, Aprile G, Kulikov E, Hill J, Lehle M, Rüschoff J, Kang YK. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, openlabel, randomised controlled trial. Lancet. 2010;376:687–97.

    Article  CAS  PubMed  Google Scholar 

  50. Flejou J-F, Paraf F, Muzeau F, et al. Expression of c-erbB-2 oncogene product in Barrett’s adenocarcinoma: pathological and prognostic correlations. J Clin Pathol. 1994;47:23–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Nakamura T, Nekarda H, Hoelscher AH, et al. Prognostic value ofDNA ploidy and c-erbB-2 oncoprotein overexpression in adenocarcinoma of Barrett’s oesophagus. Cancer. 1994;73:1785–94.

    Article  CAS  PubMed  Google Scholar 

  52. Brien TP, Odze RD, Sheehan CE, McKenna BJ, Ross JS. Her-2/neu gene amplification by FISH predicts poor survival in Barrett’s esophagus-associated adenocarcinoma. Hum Pathol. 2000;31:35–9.

    Article  CAS  PubMed  Google Scholar 

  53. Rossi E, Grisanti S, Villanacci V, et al. HER-2 overexpression/amplification in Barrett’s oesophagus predicts early transition from dysplasia to adenocarcinoma: a clinico-pathologic study. J Cell Mol Med. 2009;13:3826–33.

    Article  PubMed  Google Scholar 

  54. Hu Y, Bandla S, Godfrey TE, Tan D, Luketich JD, Pennathur A, Qiu X, Hicks DG, Peters JH, Zhou Z. HER2 amplification, overexpression and score criteria in oesophageal adenocarcinoma. Mod Pathol. 2011;24(7):899–907.

    Google Scholar 

  55. Villanacci V, Rossi E, Grisanti S, et al. Targeted therapy with trastuzumab in dysplasia and adenocarcinoma arising in Barrett’s esophagus: a translational approach. Minerva Gastroenterol Dietol. 2008;54(4):347–53.

    CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre and University of Western Australia, Perth, WA, Australia

    M. Priyanthi Kumarasinghe

  2. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and School of Pathology and Laboratory Medicine, Sydney, NSW, Australia

    Benjamin M. Allanson

  3. University of Western Australia, Perth, Australia

    Benjamin M. Allanson

  4. Interventional Endoscopist and Gastroenterologist, Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Spiro C. Raftopoulos

  5. University of Western Australia, Perth, WA, Australia

    Spiro C. Raftopoulos

  6. Gastrointestinal Pathology Service, Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA

    Gregory Y. Lauwers

Authors
  1. M. Priyanthi Kumarasinghe
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  2. Benjamin M. Allanson
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  3. Spiro C. Raftopoulos
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  4. Gregory Y. Lauwers
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Corresponding author

Correspondence to M. Priyanthi Kumarasinghe .

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Editors and Affiliations

  1. Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre and University of Western Australia, Perth, WA, Australia

    M. Priyanthi Kumarasinghe

  2. Envoi Pathology, Kelvin Grove, QLD, Australia

    Ian Brown

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Kumarasinghe, M.P., Allanson, B.M., Raftopoulos, S.C., Lauwers, G.Y. (2019). Oesophagus: Neoplastic Patterns and Mimics. In: Kumarasinghe, M., Brown, I. (eds) Endoscopic Biopsy Interpretation. Springer, Cham. https://doi.org/10.1007/978-3-319-79117-3_3

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  • DOI: https://doi.org/10.1007/978-3-319-79117-3_3

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