Histopathological spectrum of carcinoma esophagus: A 5 year retrospective study

Introduction: Due to rapid development and fatal prognosis, esophageal cancer is one of the most serious gastrointestinal cancer worldwide. Esophageal cancer incidence and histological type is extremely variable based upon geographic location, ehinicity and gender. Aim: To study the characteristics of esophageal cancer with respect to the clinical features, age, sex, histopathologic subtypes, location of tumor, in this region. Materials and Method: This retrospective study was done for a period of 5 years in the Department of Pathology GMC Jammu. Data regarding clinical features, age, sex, tumor location and histopathological diagnosis was retrieved from the request forms of the Departments of Pathology. Slides and blocks were taken from the archives of the Department of Pathology. All the slides were re-evaluated. Results: A total of 53 cases of esophageal carcinoma were identified in this study. The youngest patient was 28 years old and oldest patient was 82 years old. Male: female ratio was 1.9:1. Most patients 94% present with progressive dysphagia and weight loss while others 6% had history of chronic reflux disease. Among 53 cases, 21 specimens of esophagectomy and esophagogastrectomy were received while 32 samples were from endoscopic biopsy. Squamous cell carcinoma (SCC) was diagnosed in 47 patients while adenocarcinoma (ADC) was reported in 6 cases. Features like tumor site, tumor size, gross appearance of the tumor, histopathologic type, histopathologic grade, pTNM staging were noted. Most commonly involved site was middle esophagus (n=17) followed by proximal esophagus (n= 9) and lower esophagus (n= 6). The ratio of adenocarcinoma to SCC was 3:1 in the lower esophagus, 1:16 in the mid-esophagus and 0:1 in the upper esophagus. Among SCC cases, well differentiated tumors accounts for 41.5% of cases and moderately differentiated were 30.1%. In ADC group majority of the tumors were well differentiated (3.8%) while moderately differentiated were 7.5%. The highest TNM stage grouping recorded in resected specimens was pT3N1M0 Stage ΙΙΙa. Conclusion: Majority of esophageal carcinomas are of squamous cell carcinoma type, found mostly in middle and upper esophagus and there is increasing trend in incidence of adenocarcinoma of lower end of esophagus due to high prevalence of gastro esophageal reflux disease.