Surgical Pathology Criteria

Adenocarcinoma of the Esophagus, Esophago-gastric Junction and Gastric Cardia

Differential Diagnosis

Esophageal and EGJ High Grade Dysplasia Esophageal and EGJ Intramucosal Adenocarcinoma
Atypia confined by basement membrane Invasion beyond basement membrane
No individual epithelial cells in lamina propria Individual atypical cells in lamina propria
Architectural pattern compatible with pre-existing glands Looser definition used by some is growth in a pattern incompatible with pre-existing glands
These features are difficult to apply and subject to individual interpretation

 

  • Gastric adenoma may involve the cardia and thus could be considered in the differential diagnosis of an esophageal or EGJ adenocarcinoma
    • High grade dysplasia and invasion are not seen in adenoma
  • Esophageal Submucosal Gland Duct Adenoma Esophageal or EGJ Adenocarcinoma NOS
    Cytologically bland Cytologically dysplastic
    Two cell layers Varies from single to multiple cell layers
    Outer layer has myoepithelial phenotype No myoepithelial component
    Circumscribed Invasive

     

    Esophageal Submucosal Gland Duct Adenoma Esophageal or EGJ Adenocarcinoma, Clear Cell / Pylorocardiac Type
    Two cell layers Varies from single to multiple cell layers
    Inner layer has intensely eosinophilic cytoplasm Clear cells line tubules and papillae
    Outer layer has myoepithelial phenotype No myoepithelial component
    Lacks tumor cell necrosis Frequent coagulative tumor cell necrosis
    Circumscribed Invasive
    Clear cell / pylorocardiac adenocarcinoma may have bland cytologic features leading to confusion with an adenoma on a biopsy

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