PAGET'S EXTENSION OF ESOPHAGEAL CARCINOMA: Immunohistochemical and Mucin Histochemical Evidence of Paget's Cells in the Esophageal Mucosa

Abstract

A 68-year-old male with Paget's disease of the esophagus is reported. The underlying primary esophageal carcinoma was diagnosed as adenosquamous cell carcinoma on the basis of the presence of both adenocarcinoma and epidermoid carcinoma components. There was invasive growth of clear Paget's cells in the esophageal epithelium. Much histochemistry disclosed common characteristics of mucin between Paget's cells and adenosquamous cell carcinoma. It was histochemically confirmed that the existence of much was a general feature of extramammary Paget's disease. In 13 control esophageal carcinomas including three with adenocarcinomatous elements, Paget's cells were not found in the epithelium. To date only one case of Paget's disease of the esophagus has been described in the literature. ACTA PATHOL J P N 38: 651-658, 1988.

Paget's disease of the oesophagus associated with mucous gland carcinoma of the lower oesophagus

“…The first case report of oesophageal Paget's disease, 10 according to the table provided by Matsukuma et al ., 13 however, did not fulfil all the criteria of Paget's disease. The pagetoid cells in their case, like ours, showed a negative reaction for mucin, but unlike ours and other reported cases 11–13 no immunohistochemistry was done. In view of the underlying poorly differentiated squamous cell carcinoma in their case, the cancer cells in the surface epithelium probably represented pagetoid spread rather than Paget's disease.…”

“…The latter can be demonstrated by a positive histochemical reaction for epithelial mucin and/or a positive immunohistochemical reaction for CEA or cytokeratin 7. In addition to the present case, three previous reports 11–13 also fulfilled these criteria. The first case report of oesophageal Paget's disease, 10 according to the table provided by Matsukuma et al ., 13 however, did not fulfil all the criteria of Paget's disease.…”

“…We have already mentioned our reservation to label that case as Paget's disease. The second case in 1988 11 was associated with adenosquamous carcinoma. The third case in 1993 12 was not associated with any tumour formation.…”

“…Oesophageal Paget's disease, like other extramammary sites, however, is rare. A Medline ® search of the English literature has yielded only four cases, 10–13 to which we are adding the fifth case.…”

Paget's disease of the esophagus

“…Extramammary Paget's disease is most commonly seen in the vulva and anus and, less commonly, in the axillary area 2 . Pagetoid spread of tumor cells within the esophageal squamous epithelium was first described by Yates and Koss 6 in their report of a patient with invasive, poorly differatiated squamous cell carcinoma of the lower esophagus The second case was reported by Norihisa et al 7 . and was associated with an invasive adenosquamous carcinoma of the lower third of the esophagus.…”