Download variants of squamous cell carcinoma

Esophagus cancer
Dr Sanei
Associated professor of pathology
GI and Liver patholoogist
Pathogenesis
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food or water rich in nitrates and nitrosamines
tobacco smoke, alcohol, and various vitamin
deficiencies
achalasia
Plummer-Vinson syndrome
strictures resulting from acid or lye ingestion
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HPV types 16 and 18. 0% to 66%
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Molecular Features
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cyclin D1 and cyclin E
p53, Rb, and p16 in up to 80%
epidermal growth factor receptor (EGFR), seen
in from 29% to 92%
SQUAMOUS DYSPLASIA
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low grade and high grade
60% to 90%
erythematous, friable, and irregular in more than
80%
Erosions, plaques, and nodules
normal endoscopically
reactive epithelial changes indefinite for dysplasia
chemotherapy or radiotherapy
esophagitis secondary to reflux, or other causes
such as drug effect
INVASIVE SQUAMOUS CELL CARCINOMA
early (superficial) and late (advanced)
 middle third of the esophagus in 50% to
60% of cases
 Superficially invasive tumors are more
commonly multicentric up to 20% of cases
 fungating (60% of cases), ulcerating (25% of
cases), or infiltrative (15%
 In patients treated with preoperative
radiation or chemotherapy, the tumor may
be invisible or perhaps replaced with a
shallow surface erosion.
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cytokeratins 13, 14, 18, and 19.[65], [66] CK7 reactivity
is present in up to 29% of cases
majority of cases are negative for both cytokeratins 7
and 20
most tumors express the nuclear antigen p63
Focal positivity for neuroendocrine markers such as
chromogranin and synaptophysin
Mucin stains may show focal positivity
Differential Diagnosis
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lung squamous cell carcinomas thyroid
transcription factor F1 (TTF-1),
pseudoepitheliomatous hyperplasia
melanoma
lymphoma
pseudodiverticulosis
VARIANTS OF SQUAMOUS CELL
CARCINOMA
Basaloid Squamous Cell Carcinoma
Carcinosarcoma
Verrucous Squamous Cell Carcinoma
Lymphoepithelioma-Like Carcinoma
ADENOCARCINOMA
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More than 95% of esophageal adenocarcinomas
develop in association with Barrett's esophagus
Non–Barrett's-Associated Adenocarcinoma
extremely rare and arise either from foci of gastric
heterotopia
submucosal gland/duct system
Adenoid Cystic Carcinoma
CARCINOMA WITH MIXED SQUAMOUS AND
GLANDULAR ELEMENTS
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adenoacanthoma
adenosquamous carcinoma
mucoepidermoid carcinoma
METASTASES
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lung, breast, and stomach
renal cell carcinoma