73
1 or grade 2) adenocarcinoma is less subjective and easier than
between grade 1 and grade 2.
(B) According to Laurĕn classification, the esophageal ade-
nocarcinoma has intestinal type, diffuse type, or mixed type.
Intestinal type forms glands and resembles adenocarcinomas of
the large intestine; diffuse type has poorly cohesive cells with
little or no gland formation, often containing various propor-
tions of signet ring cells or mucinous morphology; mixed type
exhibits components of both intestinal and diffuse type carci-
nomas. The majority (around 75%) of the adenocarcinoma is
of intestinal type [ 17 ].
Signet ring or mucinous morphology often occurs together.
Cheirieac and colleagues in 2005 reported that they comprised
18% of esophageal or esophagogastric junction adenocarcino-
mas treated with surgeon alone [ 18 ].
In the literature, mucinous adenocarcinoma of esophageal
or esophagogastric junction has not been studied in details. On
the other hand, signet ring adenocarcinoma of esophagus is a
rare variant of esophageal adenocarcinoma with similar epide-
miological characteristics as usual adenocarcinoma [ 19 ]. Signet
ring adenocarcinoma of esophagus is less common than signet
ring adenocarcinoma of stomach. Gastric signet ring adenocar-
cinomas are more advanced with a greater propensity for the
peritoneal surface at the diagnosis and recurrence. In addition,
gastric signet ring adenocarcinomas are associated with better
prognosis than esophageal adenocarcinoma [ 20 ].
Turner and colleagues have reported that approximately
9% of esophageal adenocarcinoma had features of signet ring
cell carcinoma [ 19 ]. Patients with this carcinoma had more
aggressive clinical behavior and poor prognosis than conven-
tional adenocarcinoma [ 21 , 22 ]. In addition, patients with the
presence of 50% or more signet ring component in an adeno-
carcinoma had worsened clinical outcome than those with oth-
ers less than 50% signet ring component [ 23 ].
- Neoadjuvant therapy followed by surgery is the standard for
management of locally advanced adenocarcinoma of esopha-
gus and esophagogastric junction. The therapy could change
the morphology of these carcinomas. The carcinoma may
appear small or even totally disappear. Histological examina-
tion may reveal reactive changes in the carcinoma cytoplasm
(vacuolation, oncocytic changes, and neuroendocrine changes)
and nuclear atypia.
Reactions are noted in the connective tissue which may
include fibrosis, calcification, necrosis, inflammation, mucinous
degeneration (acellular mucin lakes), foamy macrophages, for-
eign body giant cells, cholesterol clefts, reactive change in fibro-
blasts, glands and vessels, etc. [ 24 ] (Figs. 3 , 4 , 5 and 6 ).
Pathology of Esophageal Adenocarcinoma
