Adenocarcinoma esophagus histopathology

1. Adenocarcinoma oesophagus and
oesophagogastric junction
Presenter: Dr G Santhi priya
Moderator: Dr Rajeev
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2. Introduction
• A malignant epithelial tumour- glandular
differentiation
• Arise predominantly from columnar(‘Barrett”)
mucosa in the lower third of the oesophagus
• Rarely – heterotrophic gastric mucosa in upper
oesophagus or from mucosal and submucosal
glands
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3. Etiology
• Hereditary
• Barrett oesophagus and GERD
• Tabacco smoking
• Overweight and obesity
• Alcohol - no
• Diet
• H . Pylori - no
• Medications
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4. Diagnostic criteria- EGJ tumors
• Tumors crossing the EGJ are classified as EGJ
tumors
• Siewerts classification
• 3 categories, based upon location of the
midpoint of the tumor
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5. Siewert’s classification
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6. Siewert’s classification
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7. Siewert’s – type II
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8. Siewert’s – type III
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9. Endoscopy
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10. Well-differentiated intramucosal
adenocarcinoma of
the esophagus associated with
high-grade dysplastic epithelium.
The lamina propria shows a
proliferation of poorly formed
glands, single cells, and clusters
of cells infiltrating the lamina
propria above the level of the
muscularis mucosae.
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11. Gross
• Polypoid/
protruding 5-
10 %
• Flat 10-15 %
• Fungating 20-
25 %
• Infiltrating
40-50%
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12. Grading
• Grade X Grade cannot be assessed
• Grade 1 Well-differentiated (greater than 95%
of tumor composed of glands)
• Grade 2 Moderately differentiated (50% to
95% of tumor composed of glands)
• Grade 3 Poorly differentiated (49% or less of
tumor composed of glands), undifferentiated
with glandular component
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13. Well-differentiated adenocarcinoma,
composed entirely of infiltrating tubular glands.
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14. Moderately differentiated adenocarcinoma
characterized by gland formation and more
marked nuclear pleomorphism.
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15. Poorly differentiated tumor composed of signet
ring cells floating in pools of mucin
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20. Staging
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21. Modified Ryan scheme for tumor
regression score
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22. TRG 1(0 % residual carcinoma)
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23. TRG 2(1-10% residual carcinoma)
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24. TRG 3(11-50% residual carcinoma)
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25. TRG 4(>50% residual carcinoma)
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26. HER2 (ERBB2)
• CD340, HER-2, HER2, and NEU
• HER2 overexpression using
immunohistochemistry (IHC) or in situ
hybridization (ISH)
• Trastuzumab for Gastric Cancer [ToGA]
• Effective in prolonging survival compared
with chemotherapy alone in patients with
HER2-positive adenocarcinoma of the stomach
and the gastroesophageal junction
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27. • Membranous protein expression of cancer cells
• Both intensity and percentage of
immunoreactive cancer cells is assessed with
scores ranging from 0 to 3+
• HER2 (ERBB2) amplification is defined as
HER2 (ERBB2):CEP17 ratio of ≥2.
• positive HER2 result requires a combination of
IHC2+ or a IHC3+ score and a positive ISH
result.
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28. • Methods
– HER2 (protein expression by
immunohistochemistry)
– HER2 (ERBB2) (gene amplification by in situ
hybridization)
– HER2 (ERBB2) (genomic test for amplification or
mutation)
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29. Four-tier scoring system for IHC
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30. Score 0, Negative
Score 1+, Negative
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31. Score 2+, equivocal
Score 3+, positive
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32. Heterogenous pattern
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33. 7/30/2019 37Symposium - PESIMSR
Her2-EFGR
transactivation
EFGR- Her2
transactivation

34. IHC
• Cytokeratins CK19,7
• A minority of cases express CK20
• AE1/AE3
• Cam 5.2
• CDX2 expression is variable
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35. References
• Bosman FT, Carneiro F, Hruban RH, Theise ND, eds.
WHO Classification of Tumours of the Digestive System.
Geneva, Switzerland: WHO Press; 2010.
• CAP (College of American Pathologists) (2017). Cancer
protocols and checklists. Available from:
http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPt
lt_actionOverride=%2Fportlets%2FcontentViewer%2Fsh
ow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionFo
rm.contentReference%7D=committees%2Fcancer%2Fca
ncer_protocols%2Fprotocols_index.html&_state=maximi
zed&_pageLabel=cntvwr online text.
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36. References
• Tumours of the oesophagus and gastro-oesophageal
junction structed reporting protocol, 2013; 1st ed.
• Chang F, Deere H, Mahadeva U, George
S.Histopathologic Examination and Reporting of
Esophageal Carcinomas Following Preoperative
Neoadjuvant Therapy Practical Guidelines and Current
Issues. Am J Clin Pathol ,2008;129:252-62
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