Desmoplasia and Detached Papillae in Early Esophageal Adenocarcinoma: A Histologic Study on Endoscopic Submucosal Dissection Specimens

Zhongbo Jin; Dongwei Zhang; Qin Zhang; Jinping Lai; Ashwin Akki; Ashwini Esnakula; Jesse Kresak; David Hernandez Gonzalo; Peter V Draganov; Hao Xie; Xiuli Liu

doi:10.14740/gr1154

Desmoplasia and Detached Papillae in Early Esophageal Adenocarcinoma: A Histologic Study on Endoscopic Submucosal Dissection Specimens

Gastroenterology Res. 2019 Apr;12(2):72-77. doi: 10.14740/gr1154. Epub 2019 Apr 7.

Authors

Affiliations

¹ Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA.
² Department of Pathology, The Third Central Hospital of Nankai University, Tianjin, China.
³ Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, FL, USA.
⁴ Division of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA.

PMID: 31019616
PMCID: PMC6469900
DOI: 10.14740/gr1154

Abstract

Background: Desmoplasia and detached papillae were only rarely mentioned in intramucosal adenocarcinoma of esophagus or stomach. This study aimed to examine these two features in early esophageal adenocarcinoma.

Methods: All endoscopic submucosal dissections specimens performed for Barrett's esophagus neoplasm during the year 2013 to 2016 were reviewed. These 44 cases included in this study were eight Barrett's esophagus with high-grade dysplasia, 21 intramucosal adenocarcinoma, and 15 submucosally or beyond invasive adenocarcinoma.

Results: Desmoplasia occurred in 73% submucosally or beyond invasive adenocarcinoma, higher than intramucosal adenocarcinoma (24%) and high-grade dysplasia (0%) (P < 0.00001 for each). The frequency of detached papillae in intramucosal adenocarcinoma and submucosally or beyond invasive adenocarcinoma specimens was 71.4% and 73.3%, higher than high-grade dysplasia (0%, P < 0.0001 for both). Univariate analysis identified desmoplasia as risk factors for lymphovascular invasion in intramucosal adenocarcinoma specimens (odds ratio 12, P = 0.048), and desmoplasia and tumor thickness for lymphovascular invasion in intramucosal adenocarcinoma and submucosally or beyond invasive adenocarcinoma specimens combined (odds ratio 9.0, P = 0.005; odds ratio 2.7, P = 0.01, respectively). Age, gender, the largest dimension and the average thickness of endoscopic submucosal dissection specimens, tumor size, detached papillae, and poor differentiation were not associated with lymphovascular invasion (P ≥ 0.05 for all). Multivariate analysis confirmed that only desmoplasia was predictive of lymphovascular invasion (odds ratio 8.0, P = 0.02) in intramucosal adenocarcinoma and submucosally or beyond invasive adenocarcinoma specimens combined.

Conclusions: In conclusion, desmoplasia occurs in about a quarter of esophageal intramucosal adenocarcinomas and three quarters of submucosally or beyond invasive adenocarcinomas, and is associated with lymphovascular invasion in early esophageal adenocarcinoma.

Keywords: Barrett’s esophagus; Desmoplasia; Intramucosal adenocarcinoma; Lymphovascular invasion; Submucosally invasive adenocarcinoma.