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Esophageal Submucosal Gland Duct Adenoma

Definition

  • Benign epithelial lesion exhibiting features of esophageal submucosal gland duct differentiation

Alternate/historic names

  • Sialadenoma papilliferum of the esophagus

Diagnostic Criteria

  • Predominantly submucosal lesion with overlying unremarkable squamous mucosa
    • Multiple communications to surface
      • May produce papillary areas
  • Circumscribed multilobulated lesion
    • Not encapsulated
    • No infiltrative pattern
  • Branching tubules and cystic lumens filled with papillae
  • All components predominantly lined by 2 layers of cells
    • May occasionally be thicker
    • Most cells cuboidal, occasionally columnar
    • Luminal layer intensely eosinophilic
    • No mucinous or gastric type cells
    • May have focal squamous differentiation
  • Uniform, bland cytology
    • Round to oval nuclei
    • Small nucleoli
    • Mitotic figures rare
  • Focal lymphoplasmacytic infiltrate with germinal centers
  • Focal acute inflammation in gland lumens and adjacent epithelium

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting : November 29, 2009

 

Supplemental studies

Immunohistology

  Basal Cells Luminal Cells
Smooth muscle actin Pos Neg
Keratins Variable positivity Strong positivity
CEA Pos Pos
S100 1 of 2 cases positive 1 of 2 cases positive
  • Keratins
    • AE1, CK7, CK5/6, CK19 positive
    • CK17, CK18 weak
    • CK20 negative
  • Negative: desmin, GCDFP15, MUC2, MUC5AC, MUC6, CK20

Differential Diagnosis

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

 

Esophageal Submucosal Gland Duct Adenoma Gastric Adenomatous Polyp, Pyloric Type
Mixed tubular and papillary pattern Tubular, no papillary component
Two cell layers One cell layer
Outer layer has myoepithelial phenotype No myoepithelial component
Inner layer has intensely eosinophilic cytoplasm Pale eosinophilic cytoplasm

 

Esophageal Submucosal Gland Duct Adenoma Esophageal or Gastric Adenomatous Polyp, Intestinal Type
Cytologically bland Cytologically dysplastic
Two cell layers One cell layer
Outer layer has myoepithelial phenotype No myoepithelial component

Bibliography

  • Rouse RV, Soetikno RM, Baker RJ, Barnard IC, Triadafilopoulos G, Longacre TA. Esophageal submucosal gland duct adenoma. Am J Surg Pathol. 1995 Oct;19(10):1191-6.
  • Harada O, Ota H, Katsuyama T, Hidaka E, Ishizaka K, Nakayama J. Esophageal gland duct adenoma: immunohistochemical comparison with the normal esophageal gland and ultrastructural analysis. Am J Surg Pathol. 2007 Mar;31(3):469-75.
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