Histopathologic findings of minute foci of squamous cell carcinoma in the human esophagus

Article Abstract:

Much of what is known about human cancer must be inferred from the examination of cancers that have already developed. Clearly, the early stages of a cancer prior to its diagnosis can not be observed. However, in some cancers the appearance of dysplasia precedes the development of cancer, and it is thought that some dysplasia represents a ''precancerous'' lesion. Dysplasia is an abnormality of tissue structure that does not have the malignant features sufficient for it to be called an actual cancer. In the case of squamous cell carcinoma of the esophagus, regions of dysplasia are often found in surgical specimens of the cancer, and many researchers have interpreted this as indicating that the dysplasia is indeed precancerous, and that the cancer actually arises from the dysplastic tissue. Recently, however, the use of the endoscope, a fiber-optic device for peering into body cavities and organs, has greatly increased the chances of finding a squamous cell carcinoma of the esophagus before it has grown larger than a single centimeter. To clarify the issues of the origin of the cancer, 16 cancers less than one centimeter were examined under the microscope. In two specimens, there were no areas of dysplasia associated with the cancer itself. In seven patients, there were areas of dysplasia that were close to, but not continuous with, the area containing the cancer, suggesting the cancer did not arise from the area of dysplasia. The authors suggest that the same conditions that lead to squamous cell carcinoma may lead to dysplasia, and therefore these two conditions may occur together in many patients. They suggest, however, that the cancer does not arise from the dysplasia, and that the dysplasia should be called a ''subcancerous'' lesion rather than a ''precancerous'' lesion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Development and progression, Squamous cell carcinoma, Precancerous conditions, Dysplasia

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Predicting recurrence time of esophageal carcinoma through assessment of histologic factors and DNA ploidy

Article Abstract:

Improvements in chemotherapy results have turned the attention of researchers to the evaluation of prognostic indicators which determine the probabilities of treatment response based on cell nuclear DNA analysis. One prognostic indicator that has received attention in recent years is the DNA content of tumor cells. Many studies of the tumor content of individual cells use flow cytometry, in which the individual cells pass one-by-one in front of an optical sensing device. However, it is also possible to use cytophotometry for the same purpose. This technique makes quantitative measurements of the light passing through the nuclei of cells viewed under the microscope. If the cells are stained with a dye that adheres to DNA (the Feulgen stain is often used), then the photometric reading may be used to infer DNA content. Cytophotometry was used to evaluate the tumor specimens of 128 patients; specimens were classed into four types based upon the distribution of different DNA contents in a sampling of 1,000 cells. These four types, labelled I through IV, were correlated with the outcome of the individual cases. Patients who survived more than five years were more likely to have type II patterns than types III or IV; the rate of recurrence within two years was 34, 60, and 77 percent for types II, III, and IV, respectively. Recurrences after five years were only observed in patients with the type II pattern. The results suggest that the cytophotometric data might be useful in planning postoperative follow-up; patients with type II patterns must be watched carefully for longer periods. Although type IV is associated with a higher rate of recurrence, type IV patients who do not experience a recurrence within two years may be regarded as cured, and required little follow-up. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Prognosis, DNA, Photometry

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Lack of muscularis mucosa and the occurrence of Boerhaave's syndrome

Article Abstract:

Boerhaave's syndrome is spontaneous rupture of the esophagus. This typically occurs in middle-aged, obese, alcoholic men who have experienced strenuous vomiting. The usual symptoms are sudden, severe pain in the lower chest or upper abdomen, preceded by violent vomiting. The actual cause of this condition is not known, although it is associated with excessive intake of alcohol, ingestion of antabuse (a drug to deter alcohol abuse), peptic ulcer, neurologic disease and hiatal hernia. A report is presented of surgical treatment of six men with Boerhaave's syndrome. All patients were between 33 to 63 (average age, 43 years) and five of the six were alcoholics. Time from onset to treatment averaged 3.4 days, and all were diagnosed by esophagogram (X-ray of the esophagus) and all showed a linear tear in the lower esophagus. Two patients underwent suturing of the tear with drainage, and two underwent esophageal resection. All patients were discharged in good condition. In all patients a sudden increase in intraabdominal pressure was the trigger for rupture. Examination of the removed specimens revealed lack of muscularis mucosa at the site of rupture. Little is known of the physiologic role of muscularis mucosa, but in normal anatomy it extends from the pharynx to the stomach. The lack of muscularis mucosa may be linked to Boerhaave's syndrome. The mucosa may act as a buffer, absorbing the increased pressure within the lumen of the esophagus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Abnormalities, Esophagus, Mucous membrane

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