Pathology of esophageal cancer, esophageal cancer is the most common esophageal disease, esophageal diseases accounted for 70% — 90%, sarcoma only 2% of esophageal cancer. Esophageal cancer in the esophageal mucosa, mostly squamous cell carcinoma, adenocarcinoma can occur in the following paragraph; occasionally squamous cell carcinoma and adenocarcinoma in combination for squamous carcinoma. Primary adenoid cystic carcinoma of the esophagus is rare. Adenocarcinoma of the esophagus can occur in normal glands, ectopic gastric mucosa can also occur, often metastatic, highly malignant. Small cell undifferentiated carcinoma of the esophagus is a rare malignancy. Cancer Hospital, Chinese Academy of Medical Sciences (hereinafter referred to as the Medical Oncology Hospital) 30 years, 22 cases of clinical features of fast growth, highly malignant, more surgery in about six months after death; general often has polyps, mushroom umbrella and medullary type. Carcinosarcoma is a containing both epithelial and mesenchymal malignant transformation of the tumor, esophageal sarcomas are rare.
Esophageal cancer can grow to the cavity, the cavity wall invasion and growth can be directly in the submucosal layer in the up, down spread. Serosa due to esophageal no, it is very easy after tumor invasion through muscularis and adjacent organs, such as the trachea, bronchus, lung, pleura and pericardium Qing, et al. Lymphatic metastasis common. Advanced cases, hematogenous metastasis can occur.
Esophageal cancer in men are more 50 million people in North China in recent years, epidemiological survey found that the proportion of male and female patients an average of 1.6:1 to 1:1; the more high incidence, the difference between male and female incidence smaller.
Esophageal cancer occurred in the prime of life and old age, 30 years of age is rare, increasing gradually increased with age. Li Guangheng other provinces a total of 1831 cases in North China, the highest incidence in the age group 50 to 59 years (618 cases, accounting for 33.8%) and 60-69 (593 cases, accounting for 32.4%).
Esophageal cancer in the middle the most, followed by lower, upper least.
Esophageal cancer pathology 1. Early esophageal cancer pathology of early esophageal cancer, including carcinoma in situ and early invasive carcinoma, in addition to a small number of papillary, a number of no obvious mass formation, is limited to minor changes in the mucosal surface, but the size range uncertain. According to the pathological features can be divided into the following four types:
(1) HIDDEN esophageal lesions do not sag, not uplift, consistent with the surrounding normal mucosa. Fresh specimens slightly darker than normal color of the lesion, local capillaries increased, dilatation and congestion and inflammatory infiltration. This type of esophageal cancer in the surgical specimens rare.
(2) slightly erosive mucosal lesions with mild depression or erosion, irregular margin, were map-like, clear boundaries with normal tissue, erosion of the area was fine granular; section shows the local mucosal defect. In the surgical resection of early esophageal cancer specimens, these are more common.
(3) plaque-type lesions was slightly higher from the mucous membrane, swelling, surface rough, even shows a small erosion area. The longitudinal and transverse esophageal folds thicken or interruption. Mucosal lesions was significantly thicker than the normal section, largely confined to the lamina propria, a few involving submucosa. The majority of surgical resection of early esophageal cancer are of this type.
(4) papillary lesions or papillary mucosa was high from the polypoid diameter usually 1 ~ 3cm, protrusion into the lumen, clear boundaries with the surrounding normal mucosa, smooth surface, with occasional small erosion. This type of early esophageal cancer are very rare.
2. In advanced esophageal cancer in the pathology
(1) medullary type tumor extension outside the esophagus, esophageal wall thickening significantly. Esophageal tumors involving all or most of the perimeter, to highlight the lumen to the lumen outside the spread of the mucosal surface of the ulcer often shades. This type is most common.
(2) fungating tumor mostly flat oval, raised in the esophageal lumen, showing mushroom umbrella. Tumor margin uplift, and often valgus. Tumor surface often shallow ulcers.
(3) ulcerative type tumor tissue formed on the surface of a deep ulcer, ulcer edge is not sharp, slightly higher, the ulcers are often deep muscular layer or the end of myometrial penetration.
(4) narrowing the type of tumor infiltration in the esophagus, often involving the esophagus for the week, so that the narrow circular tube formation. Link shorter long lesions. Esophagus showed concentric contraction, a significant expansion of the proximal esophagus.
(5) cavity type of bulky tumors in most cases, polypoid, nodular, spherical or sausage-shaped, the growth of the esophageal lumen. Most shallow irregular tumor surface erosion surface, and some have irregular ulcers, mucosal surface of a small number of tumors compared finishing. Few cases, the root of pedunculated tumor.
Esophageal cancer pathology 3. Esophageal cancer and metastatic spread of the basic ways are the following:
(1) within the spread of the esophagus is a common phenomenon. Esophageal cancer often along the lamina propria or submucosa infiltration of lymphatic vessels can form a nodular mucosal surface uplift, resembles a second primary cancer. Some people think that the bottom of the adjacent epithelial cell cancer or carcinoma in situ is also one way of surface diffusion.
(2) direct infiltration of adjacent organs is a major proliferation of esophageal cancer in another way. Upper esophageal carcinoma often invade the larynx, trachea and neck soft tissue, and even penetrated the thyroid gland. Bronchial invasion of esophageal cancer often form the esophagus – bronchial fistula; also can invade the thoracic duct, azygos vein, hilar and lung tissue; a few cases, invasive carcinoma aorta, the formation of the esophagus – aortic fistula and bleeding death. Esophageal cancer can affect cardiac and pericardial.
(3) lymph node metastasis are more common metastatic sites and its direction on esophageal lymphatic drainage. Generally believed that cancer often transferred to the middle or hilar lymph nodes near the esophagus, can also be transferred to the neck and mediastinum upward, downward transferred to the cardiac side or the left gastric artery lymph nodes. Carcinoma often transferred to the lower esophagus, cardia side, left gastric artery paraneoplastic and abdominal lymph nodes, occasionally also up first mediastinal or cervical lymph node metastasis. Esophageal cancer metastasis to the mediastinum, followed by the abdomen and the trachea and esophagus. Medical Oncology Hospital, 858 resection specimens, there were 361 cases of lymph node metastasis, accounting for 42.1%.
Esophageal cancer pathology, (4) blood of patients with advanced esophageal cancer metastasis often occurs hematogenous metastasis. To transfer to the liver and lung the most common, can also be transferred to the bone, kidney, omentum, and peritoneum, and adrenal.