Kichishiro Fujita

Double muscularis mucosae in Barrett's esophagus

To clarify the histology and morphogenesis of the double muscularis mucosae in Barretts esophagus, eight specimens resected from patients with Barretts esophagus were compared histopathologically with 352 specimens resected from patients without Barretts esophagus. A double muscularis mucosae was observed in seven (87.5%) of the eight cases with Barretts esophagus, but in none of the 352 cases without Barretts esophagus. The mucosa in the segment of Barretts esophagus consisted of columnar epithelium, a superficial lamina propria, a superficial muscularis mucosae, a deep lamina propria, and a deep muscularis mucosae. The distal end of the superficial muscularis mucosae was connected to the deep muscularis mucosae at the esophagogastric junction, and its proximal end was located in fibrous tissue below the squamocolumnar junction of the mucosal epithelium or the distal edge of the erosive lesion. The deep muscularis mucosae in the portion with Barretts esophagus was continuous with the original muscularis mucosae of the proximal esophagus and muscularis mucosae of the stomach. Barretts esophagus is considered to be not merely a metaplastic lesion within the epithelium, but a newly developed lesion containing columnar epithelium, lamina propria, and a superficial muscularis mucosae on the lamina propria of the esophageal mucosa.

Prognostic significance of intramural metastasis in patients with esophageal carcinoma.

Clinicopathologic data on 201 patients who underwent surgical resection of esophageal squamous cell carcinoma, with or without intramural metastasis (IM), were analyzed to determine the significance of IM for patient prognosis and survival. In 24 (11.9%) patients IM was observed. There was one (1.4%) in 74 cases in Stage 0, I, or II, and 23 (18.1%) in 127 cases in Stage III or IV, based on the new pTNM classification. There was a statistically significant Cox‐Mantel test difference in the percentage survival curves of the patients, both in all stages (P < 0.01) and in only Stages III and IV (P < 0.05), as a function of the presence or absence of IM. Lymph node metastasis and distant organ metastasis were observed in 22 (91.7%) and seven (29.2%) of the 24 patients, respectively, with IM and in 111 (62.7%) and 13 (7.3%) of the 177 patients without IM. For both types of metastasis, the incidence was significantly lower in the patients without IM (P < 0.01). Seventy percent of IM on the proximal side was detected during preoperative clinical examination. These data indicate that the presence of IM is an important factor for preoperative and postoperative evaluation of the prognosis of patients with esophageal squamous cell carcinoma.

Basaloid‐Squamous Carcinoma of the Esophagus with Marked Deposition of Basement Membrane Substance

A 71 year old Japanese man with basaloid‐squamous carcinoma of the esophagus is reported. The carcinoma contained basaloid cells, a few small cornified foci, and a large amount of eosinophilic hyaline substance, which reacted positively upon periodic acid Schiff, type IV collagen, and laminin staining. Ultrastructural examination revealed markedly replicated basement membranes (BM). The morphological findings suggested that this tumor secreted abundant BM substance. Small nests of cancer cells were attached to the dysplastic esophageal epithelium. The tumor cells exhibited negative staining for mucin, secretory component, lactoferrin, and carcinoembryonic antigen. These findings, as well as the observed keratini‐zation and attachment between the carcinoma nests and mucosal epithelium, indicate that the tumor originated in the mucosal epithelium of the esophagus. Acta Pathol Jpn 41: 59–64, 1991.

Intraductal spread of esophageal squamous cell carcinoma

In order to determine the pathways of tumor dissemination in esophageal carcinoma, 175 lesions of squamous cell carcinoma of the esophagus were studied histopathologically and by electron microscope in relation to the intraepithelial spread and involvement of the esophageal glands by the carcinoma. The study compared vessel invasion and lymph node metastasis. Intraepithelial spread was seen in 111 lesions (63%) and gland duct involvement in 33 lesions (19%). Gland duct involvement was observed in 30% of the lesions positive for intraepithelial spread. In the intramucosal carcinomas, gland duct involvement was observed in 24%. Even in a very small carcinoma 7 × 5 mm in size, ductal spread was detected. This carcinoma did not reach the submucosa through stromal invasion. Patients with intramucosal carcinoma showed low incidence (20%) of lymphatic and/or blood vessel invasion and no incidence of lymph node metastasis. Examination by electron microscope showed that the cancer cells of the intraepithelial spread entered the duct by raising the normal ductal epithelium in the ductal cavity although the basal lamina was retained. Normal gland duct cells and cancer cells were either attached with desmosomes directly or were separated by degenerated epithelial cells. A high incidence of ductal involvement of the esophageal glands was seen in squamous cell carcinoma of the esophagus, indicating its possible importance as a route to the deep tissue in the early stage of this carcinoma.

Primary malignant melanoma of the esophagus

The case of a 54-year-old man with primary malignant melanoma of the esophagus is described. The results of morphologic examination are presented, and the histogenesis of the tumor and the classification of melanomas are briefly discussed. Histologic examination suggested that this was a case of primary malignant melanoma of the esophagus arising from melanosis of the esophageal mucosa. Like melanomas from the oral mucosa, vagina, anus, and vulva, the tumor had lentiginous radial components.

Morphological Heterogeneity of Esophageal Carcinoma

To clarify the morphological heterogeneity of esophageal carcinoma, the adenocarcinomatous, basaloid, and sarcoma‐like components of 178 esophageal carcinomas were studied with regard to histopathology, much histochemistry, immunohistochemistry, and ultrastructure. Adenocarcinomatous components with mucicarminophilic cells and/or glandular structures, basaloid components, and sarcoma‐like components were found in 55 lesions (30.9%), 17 lesions (9.3%), and five lesions (2.8%) respectively. Carcinoembryonic antigen staining was positive in 52 lesions (29.2%), secretory component staining was positive in 15 (8.4%), and lactoferrin staining was positive in 12 (6.7%). Eight intraepithelial carcinomas were found to have no adenocarcinomatous components, and two intramucosal carcinomas had adenocarcinomatous components in the invasive portions. These findings strongly suggest that the adenocarcinomatous components do not arise from the ductal epithelium, but occur during the process of invasion. There were no significant clinicopathological differences between the carcinomas with adenocarcinomatous components and those without. Ultrastructurally, the adenocarcinomatous components were seen to possess intracellular microcysts, intercellular lumina, and bundles of tonofilaments, having features of both glandular and squamous epithelia. On the basis of the concept that the basaloid components are histological variants of squamous cell carcinoma and that sarcoma‐like components arise from mesenchymal metaplasia of squamous cell carcinoma, it is possible that the three components may originate from the squamous component. The present study thus demonstrated a high incidence of histological variation among esophageal carcinomas.

Junctions between intraepithelial carcinoma and non-neoplastic tissue of the esophagus

This report describes light and electron microscopic observations in 11 patients with intraepithelial carcinomas concomitant with invasive squamous cell carcinomas of the esophagus. The junctions between the intraepithelial carcinomas and non‐neoplastic tissues were examined using an electron microscope. Vertical sections through the basal laminae revealed intraepithelial carcinomas with bulky outgrowths and simple replacement histological patterns. The bulky outgrowths contained many pseudopodial cytoplasmic projections from the tumor cells through the basal laminae, while the simple replacement patterns included rare small breaks in the basal laminae. Horizontal sections parallel to the basal laminae showed that the cells of the poorly differentiated squamous cell carcinoma were readily distinguishable from the non‐neoplastic cells in the surface layer of the esophageal epithelia and distinctly smaller and darker than the normal prickle cells. At most of the junctions, mesenchymal cells, degenerated cells, and amorphous material separated the tumor cells from the non‐neoplastic epithelial cells. However, tumor cells were occasionally attached directly to normal epithelial cells with well‐developed desmosomes. Ductal involvement of the carcinomas was found in the submucosal esophageal gland proper. The tumor cells invaded between the ductal cells and basal laminae, and neoplastic cells were also directly attached to the benign ductal cells by poorly‐developed desmosomes. The host‐tumor junctions in the intraepithelial carcinomas of the human esophagus consisted of basal laminae with hemidesmosomes and pseudopodial projections, mesenchymal cell accumulations and direct attachments with desmosomes.

Polypoid type of early squamous cell carcinoma of the esophagus

SummaryAn 80-year-old female with a polypoid type of early squamous cell carcinoma of the esophagus is described. The results of morphological examination of the tumor are reported and briefly discussed. Despite the unique gross appearance, the histology and electron microscopy of this tumor were not distinct from those of usual squamous cell carcinomas of the esophagus.

Small Cell Carcinoma of the Esophagus: Report of Three Cases and Review of Literature

Undifferentiated small cell carcinoma is a highly malignant tumor arising usually from the lung. This lung tumor is distinct from the other types of tumors in terms of biological and clinical behavior. Responses to multi-drug combinations are seen in over 80% of lung small cell carcinomas, whereas they are frequently disseminated and the outcome after surgery as primary therapy is terrible [1–3]. Therefore, small cell carcinomas of the lung are mostly treated with radiation and chemotherapy even in early stages of disease.