Mucosal Squamous Cell Carcinoma of the Esophagus: A Clinicopathologic Study of 30 Cases

Abstract

A clinicopathologic study was carried out on 30 patients with mucosal esophageal cancer (MEC). The depth of cancer invasion was subdivided histologically into three categories: m₁ = carcinoma in situ (intraepithelial carcinoma) or carcinoma with questionable invasion beyond the basal membrane; m₂ = cancer invasion confined to the lamina propria, and m₃ = cancer reaching to or infiltrating into the muscularis mucosae. Lymph node metastases and lymphatic invasion were found only in the tumors reaching or infiltrating the muscularis mucosae (m₃). The maximum histologic vertical extent of the tumors was more than 1 mm in 4 of 5 patients with lymph node metastasis or lymphatic invasion. None of the patients died of recurrent esophageal disease, and 3 of the 6 patients who had a second primary tumor died of this other malignancy. It is critical to distinguish between m₁, m₂ and m₃ tumors to plan a treatment strategy, including an endoscopic mucosal resection.

Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for superficial esophageal neoplasia. Is it safe for elderly patients?

“…Endoscopic mucosal resection (EMR) is indicated for the treatment of early-stage gastrointestinal neoplasias, which reveal low frequency of lymph node and distant metastasis because it allows for less invasive treatments and thereby improving the quality of life compared with surgery [21][22][23][24][25]. In squamous-cell neoplasias of the esophagus, intraepithelial carcinoma (m1) and intramucosal carcinoma limited to the lamina propria mucosae (m2) without lymph vascular involvement have very rare risk of lymph node and distant metastasis [26,27]. In columnar neoplasias, lymph node metastasis rarely occurs in intramucosal lesions without lymph vascular involvement [28,29].…”

Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasias

“…In squamous cell neoplasias of the esophagus, intraepithelial carcinoma (m1) and intramucosal carcinoma limited to the lamina propria mucosae (m2) without lymph vascular involvement have very rare risk of lymph node and distant metastasis [22,23]. In columnar neoplasias, lymph node metastasis did not occur in intramucosal lesions without lymph vascular involvement [24,25].…”

Surgical treatment of superficial esophageal cancer

“…The majority of patients with SEC have lymph node involvement confined to the regional nodes (N1M0). Distant (cervical and celiac axis, N1M1lym) lymph node metastasis was present between 16.7 and 33.3% [43,44,[46][47][48], whereas skip metastasis to the distant nodes (N0M1lym) was rare ( Table 2). In T1b SECs, lymph node metastasis was restricted to one field in most cases, ranging from 60 to 83.3% [40][41][42][43][44]49]; two-field involvement was occasional (16.7-40%) [40,41,43,44,49] and three-field metastasis was rare.…”