70
Dysplasia is a neoplastic stage of the epithelium in which
there is the presence of cytological as well as architectural
atypia of the glandular epithelium. As distinct from adenocar-
cinoma, there is no invasion of basement membrane of the
lesion into lamina propria in dysplasia.
The presence of dysplasia in Barrett esophagus may some-
times be uncertain especially in GORD and Barrett esophagus
there could be reactive changes because of inflammation. The
term “indefinite for dysplasia” is sometimes applied. For dys-
plasia, the most common classification is to divide it into low-
grade dysplasia and high-grade dysplasia depending on the
severity of cellular and architectural changes (Fig. 2 ).
There is also a lesion called intra-mucosal adenocarcinoma
in which the lesion has invaded into the lamina propria but still
confined to the mucosa. This lesion is difficult to differentiate
from high-grade dysplasia.
The management of the patients with dysplasia depends
on the endoscopic appearance (flat versus nodular) and the his-
tology (indefinite for dysplasia, low-grade dysplasia, high-
grade dysplasia, intra-mucosal adenocarcinoma) [ 5 ].
(B) Adenoid cystic carcinoma
Esophageal adenoid cystic carcinoma is a rare type of ade-
nocarcinoma. The carcinoma often has cribriform as well as
solid pattern of glands with cystic areas containing mucinous
or eosinophilic secretions. It is likely that the carcinoma devel-
oped from cells in the differentiation direction of esophageal
glands. It is reported often in Asian populations in Japan or
China. The prevalence of this cancer is approximately 0.1% of
all esophageal malignancies [ 7 ].
Pertussion is the first to review the features of esopha-
geal adenoid cystic carcinoma in the literature in 1986 [ 8 ].
The author reviewed 45 cases of esophageal adenoid cystic
carcinoma in literature and concluded that it is biologically
more aggressive that the adenoid cystic carcinoma of salivary
gland. Zhou and colleagues also reviewed features of 18
cases of esophageal adenoid cystic carcinoma from China in
2014 [ 9 ]. Similar to esophageal squamous cell carcinoma,
the carcinoma most commonly noted in the middle portion
of the esophagus.
Chemotherapy is not often used to treat the cancer due to
a poor response rate of esophageal adenoid cystic carcinoma to
chemotherapy [ 10 ]. With regard to the prognosis, studies
demonstrated conflicting findings. Nevertheless, Sawda and
colleagues recently reviewed 35 cases in Japanese literature and
they concluded that patients with esophageal adenoid cystic
carcinoma had lower incidence of lymph node metastasis and
relatively better prognosis when compared with those with
esophageal squamous cell carcinoma [ 11 ].Alfred K. Lam