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Pathology - Oesophageal carcinoma
Definition • A malignant epithelial neoplasm originating in the oesophagus. • Two primary subtypes are identified: squamous cell carcinoma and adenocarcinoma.
Epidemiology • Both forms manifest at a median age of 65 years. • Oesophageal adenocarcinoma has garnered significant attention in developed nations due to its substantial and persistent increase in incidence over recent decades.
Aetiology • Significant tobacco and alcohol consumption is associated with squamous cell carcinoma. • Chronic gastro-oesophageal reflux disease resulting in Barrett’s oesophagus is the predominant precursor to adenocarcinoma. Carcinogenesis • Both forms commonly possess TP53 mutations.
Presentation: Dysphagia, retrosternal or epigastric discomfort, and weight loss. • By the time the majority of individuals seek medical attention, the tumor is typically in an advanced stage.
Macroscopy • Tumor mass in the esophagus may exhibit exophytic growth into the lumen or infiltrate the wall in a plaque-like manner. • Squamous cell carcinomas typically arise in the mid-esophagus, whereas adenocarcinomas are generally found in the lower esophagus.
Histopathology • Squamous cell carcinomas exhibit infiltrating malignant epithelial cells demonstrating squamous differentiation, characterized by intercellular bridges and/or keratinization. • Adenocarcinomas display infiltrating malignant epithelial cells evidencing glandular differentiation, indicated by tubule formation and/or mucin production. The neighboring oesophageal mucosa may exhibit high-grade dysplasia in a region of Barrett’s oesophagus.
Prognosis: Generally unfavorable due to delayed presentation. • Five-year survival rates around 10–20%
TNM 7 pathological staging of oesophageal carcinoma
Primary tumour (T)
pT1a: tumour invades no deeper than the submucosa.
pT2: tumour invades the muscularis propria.
pT3: tumour invades the adventitia.
pT4: tumour invades adjacent structures.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: 1 or 2 regional lymph node metastases.
pN2: 3–6 regional lymph node metastases.
pN3: 7 or more regional lymph node metastases
Definition • A malignant epithelial neoplasm originating in the oesophagus. • Two primary subtypes are identified: squamous cell carcinoma and adenocarcinoma.
Epidemiology • Both forms manifest at a median age of 65 years. • Oesophageal adenocarcinoma has garnered significant attention in developed nations due to its substantial and persistent increase in incidence over recent decades.
Aetiology • Significant tobacco and alcohol consumption is associated with squamous cell carcinoma. • Chronic gastro-oesophageal reflux disease resulting in Barrett’s oesophagus is the predominant precursor to adenocarcinoma. Carcinogenesis • Both forms commonly possess TP53 mutations.
Presentation: Dysphagia, retrosternal or epigastric discomfort, and weight loss. • By the time the majority of individuals seek medical attention, the tumor is typically in an advanced stage.
Macroscopy • Tumor mass in the esophagus may exhibit exophytic growth into the lumen or infiltrate the wall in a plaque-like manner. • Squamous cell carcinomas typically arise in the mid-esophagus, whereas adenocarcinomas are generally found in the lower esophagus.
Histopathology • Squamous cell carcinomas exhibit infiltrating malignant epithelial cells demonstrating squamous differentiation, characterized by intercellular bridges and/or keratinization. • Adenocarcinomas display infiltrating malignant epithelial cells evidencing glandular differentiation, indicated by tubule formation and/or mucin production. The neighboring oesophageal mucosa may exhibit high-grade dysplasia in a region of Barrett’s oesophagus.
Prognosis: Generally unfavorable due to delayed presentation. • Five-year survival rates around 10–20%
TNM 7 pathological staging of oesophageal carcinoma
Primary tumour (T)
pT1a: tumour invades no deeper than the submucosa.
pT2: tumour invades the muscularis propria.
pT3: tumour invades the adventitia.
pT4: tumour invades adjacent structures.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: 1 or 2 regional lymph node metastases.
pN2: 3–6 regional lymph node metastases.
pN3: 7 or more regional lymph node metastases
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