Adenocarcinoma of the Esophagus, Esophago-gastric Junction and Gastric Cardia
Definition
- Malignant gland forming neoplasm of the esophagus, and esophago-gastric junction
Diagnostic Criteria
- Most are papillary and/or tubular
- May have focal other differentiation
- Endocrine, Paneth cell or squamous
- Adenocarcinoma NOS is defined by invasion, significant dysplasia and evidence of glandular/mucinous differentiation
- Clear cell variant may be the same as pylorocardiac type (Carr)
- Both described as having clear to pale eosinophilic cytoplasm
- Tubulo-papillary architecture
- Dysplasia ranges from minimal to severe
- Round basal or mid-level nuclei in lower grades
- Location in cardia and pylorus
- Pylorocardiac type reported variably as mucin positive and negative
- Not well described in recent literature
- Clear cell variant has one recent description (Ghotli)
- Clear cells make up 30-100% of cells
- Glycogen positive, rare mucin positive cells
- CK7 67%, CK20 33%
- CEA, CDX2, E cadherin (membrane), cyclin D1 100%
- AFP negative
- Mucinous and signet ring types rare
- Both defined as in the large intestine
- >50% of tumor area must be composed of mucin or >50% of cells must be signet ring
- Rare variants and types
- Adenosquamous
- Mixture of two patterns, more than just focal
- Mucoepidermoid
- Same features as salivary gland tumors
- There has been debate about how to describe the location of tumors near the esophago-gastric junction (EGJ)
- AJCC 7th edition includes as EJG adenocarcinomas all tumors that cross the junction unless the center of the tumor is >5cm from the junction
- Such carcinomas are staged as esophageal
- Tumors of the proximal stomach that are >5cm from the junction or do not cross the junction are staged as gastric
- AJCC 7th edition includes as EJG adenocarcinomas all tumors that cross the junction unless the center of the tumor is >5cm from the junction
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting/last update: 11/29/09, 7/17/11, 11/24/11, 11/26/11
