Abstract
Aim: The aim of this study is to evaluate the various clinicopathological factors and correlate with mucin histochemical features in patients with the adenocarcinoma of the esophagus, all of whom underwent total esophagectomy.
Material & Method: Data of a total of forty five patients with adenocarcinoma of the esophagus, all patients having undertaken total esophagectomy at Department of Surgery, AIIMS, New Delhi in between January 1980 and December 1995, were retrospectively analysed for study. All these patients were divided into two groups, cases (21) and controls (24); depending on the outcome of interest at 24 months (i.e. death or survival); controls being the patients, who survived for 24 months. Patients were evaluated with reference to clinicopathological variables and mucin histochemistry. Sections were stained by the Alcian Blue / Periodic Acid Schiff & High iron Diamine Alcian Blue technique to identify neutral mucin and acid mucin (sialomucin and sulphomucin).
Results: It is apparent from this study, that the well-known clinicopathological variables like age, sex, consumption of tobacco &alcohol, symptoms, location, differentiation, stage, that affect survival were in no way different in cases and controls. Therefore, role of mucin histochemical characteristics were explored and it was found that presence of mucin (acid / neutral) in any location (intracellular / extracellular) may be associated with poor prognosis. Again among the extracellular acid mucins, sulphomucin is almost associated with worse prognosis.
Conclusion: Well known clinicopathological variable that affect poor survival were analysed retrospectively, for adenocarcinoma esophagus who underwent esophagectomy; 24 months being taken as the outcome of interest (death or survival); control were the patients who survived for 24 months. No statistically significant difference was found among clinicopathological variables. However, mucin histochemical characteristics and amongst these extracellular acid mucin; sulphomucin is almost always associated with poor prognosis.
References
- Freddie B, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin. 2018;68:394-424.
- Griesenger KR, Teot LA and Richter JE. A comparative cytopathological and histological study of atypaia, dysplasia and adenocarcinoma in Barrett’s Esophagus. Cancer 1992; 69.
- Pera M, Trastek VF, Pairolero PC et al. Barrett’s Disease : Pathophysiology of Metaplasia and Adenocarcinoma. Ann Thorac Surg 1993; 56: 1191-1197.
- Allison PR and Johnstone AS. The esophagus lined with gastric mucus membrane. Thorax 1953; 8: 87 -101.
- Mckinely M, Sherlock P. Barrett’s esophagus with adenocarcinoma in Scleroderma. Am J Gastroenterol 1984; 79:438.
- Cameron AJ, Ott BJ, Payne WS. The incidence of adenocarcinoma in columnar lined (Barrett’s) esophagus. N Engl J Med 1985; 313 : 857.
- Turnbull AD, Godner JJ. Primary adenocarcinoma of the esophagus, cancer 1968; 22: 915-918.
- Cederqvist E, Nielsoen J, Berthelsen A and Hansen HS. Adenocarcinoma of the esophagus. Acta Chir Scand 1980; 146: 411-415.
- Reid L and Clamp JR. The biochemical and histochemical nomenclature of mucins. Br Med Bull 1978; 34: 5-8.
- Bozymski EM, Herlihy KJ, Orlando RC Barrett’s esophagus,. Ann Intern Med 192; 97: 103-107.
- Jass JR and Filipe MI. the mucin profiles of normal gastric mucosa, intestinal metaplasia and its variants and gastric carcinoma. Histochem J 1981; 13 : 931-939.
- Jass JR and Filipe MI. A variant of intestinal metaplasia associated with gastric carcinoma : A histochemical study. Histopoathology 1979; 3 : 191-199.
- Fein R, Kelsen DP, Geller N, Bains M, McCormack P and Brennan M. Adeocarcinoma of the Esophagus and Gastro-esophageal Junction: Prognostic factors and Results of Therapy. Cancer 1985: 56: 2512-2518.
- Rothwell JF, Feehan E, Reid I, Walsh TN and Hennessy TPJ. Delay in treatment for oesophageal cancer. Br. J Surg 1997; 84: 690-693.
- Launois B, Paul JL, Lygidakis N J et al. Results of the surgical treatment of carcinoma of the esophagus, Surg Gynaecol Obstet 1983; 1156: 753-60.
- Sugimachi K, Matsuoka H, Matsnfuji H et al. Survival rates of women with carcinoma of the oesophagus exceed those of men. surg Gynae & Obst 1987; 164:541-544.
- Sugimachi K, Matsuoka H, Ohno S, Mori M. Multivariate approach for assessing prognosis of clinical oesophageal carcinoma. Br. J Surg 1988; 75: 1115 – 1118.
- Skinner DB. Enoblock resetion for neoplasia of the oesophagus and cardia. J thorac card vasc Sur 1983 ; 85 : 59-71
- Shah M and Shrikhande SS. Mucin histochemistry of the upper gastrointestinal tract. Indian J Gastroenterol 1989; 8 : 83-84.
- Jass JR, Mucin histochemistry of the columnar epithelium of the oesophagus : A retrospective study. J. Clin Pathol 1981; 34 : 866-870.
- Haggitt RC, Tryzelaar J, Ellis FH, Colcher H. Adenocarcinoma complicating columnar epithelium lined (Barrett’s) esophagus. Am J Clin Pathol 1978; 70 : 1-5.
Corresponding Author
Dr Diptimay Das
Associate Professor, Department of Radiotherapy, Burdwan Medical College & Hospital
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.145
