Pathology

Oesopahgeal tumours are classified into

• epithelial tumours - include papilloma, intraepithelial neoplasia, carcinoma and carcinoid tumours
• non epithelial tumours - leiomyoma, lipoma, gastrointestinal (1)

Squamous cell carcinoma (SCC) is the predominant histological subtype and is mainly found in the upper two thirds of the oesophagus.

• is thought to develop from squamous dysplasia/intraepithelial neoplasia.
  • dysplastic squamous epithelium is characterised by cytologic and architectural abnormalities
  • these lesions are usually confined to the epithelium
• invasion of these neoplastic squamous cells into lamina propria and deeper layers results in invasive oesophageal SCC (2,3)

Adenocarcinoma usually arises in a region of specialised columnar epithelium (SCE) metaplasia in the lower third of the oesophagus.

• there is glandular differentiation that arises in the setting of Barrett’s oesophagus (BE)
• rarely may arise from heterotrophic gastric tissue or the submucosal glands with a similar morphology to Barrett’s associated tumours (2,3)

Dissemination of the tumour may occur in three ways:

• direct spread - occurs both laterally, through the component layers of the oesophageal wall, and longitudinally within the oesophageal wall
• via lymphatics - occurs commonly
• haematogenous spread - spread may involve a variety of different organs including the liver, lungs, brain and bones (3)

Reference:

• (1) Rashid N et al. Current management of oesophageal cancer. BJMP 2015;8(1):a804
• (2) Jain S, Dhingra S. Pathology of esophageal cancer and Barrett’s esophagus. Ann Cardiothorac Surg. 2017; 6(2): 99–109
• (3) Williams N, Bulstrode CJK, O’Connell PR (2008). Bailey & Love’s short practice of surgery (25th ed.). London