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- Barrett mucosa is considered a precursor to esophageal adeno-
carcinoma [ 13 ]. Barrett mucosa may be identified macro-
scopically as a velvety texture at the distal esophagus mucosa
distinct from the smooth squamous mucosa that extends
proximally. Its presence or absence and relation to the tumor
are useful for the distinction between adenocarcinoma of the
distal esophagus and proximal stomach, which are etiologi-
cally distinct. It may involve the distal esophagus circumfer-
entially or partially and the new squamocolumnar junction is
often irregular. Occasionally, Barrett mucosa may appear as
islands, separated from the gastro-esophageal junction by
normal squamous mucosa. Barrett mucosa should be con-
firmed by microscopy.
- Lymph nodes may be more difficult to locate following che-
motherapy and radiotherapy. However, all lymph nodes should
be harvested and examined histologically. The lymph nodes
must be embedded in such a way to ensure that the numbers
of involved and uninvolved lymph nodes can be quantified. In
completely resected carcinomas, lymph node status is the most
important independent prognostic factor [ 5 , 7 , 14 ].
- An example of a typical block key for this kind of specimen is
given below:
Block key:
1A Proximal margin.
1B Distal margin.
1C–D Tumor to circumferential margin.
1E–F Proximal and distal tumor to mucosa.
1G–H Gastro-esophageal junction.
1I–K 4 whole lymph nodes per block.
1 L–N 1 bisected lymph node per block.
- A typical microscopic report includes following features:
MICROSCOPIC
Tumor location.
Histologic type.
Histological grade.
Maximum tumor dimension.
Depth of invasion.
Peritoneal involvement.
Pleural involvement.
Lymphatic and capillary space invasion.
Vein and artery space invasion.
Perineural invasion.
Cut Up of Resected Specimen of Esophageal Adenocarcinoma
