Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands.
Dis Esophagus. 2012 Sep-Oct;25(7):630-7. doi: 10.1111/j.1442-2050.2011.01300.x. Epub 2012 Jan 3.
Barrett's esophagus (BE) is a premalignant condition with an increased risk of developing esophageal adenocarcinoma (EAC). Risk factors for EAC overlap with those for esophageal squamous cell carcinoma (ESCC), but ESCC is surprisingly rare in BE. We report two cases of ESCC directly surrounded by BE. Both patients had a previous medical history of cancers, i.e., head and neck squamous cell carcinomas, and were using alcohol and smoking tobacco. Using immunohistochemistry for p63, CK5, CK7, and CDX2, it was confirmed that these carcinomas were pure squamous cell carcinomas, and not EACs or esophageal adenosquamous carcinomas arising from BE. Using TP53 mutation and loss of heterozygosity analysis, we established that the ESCCs in BE were not metastases of the previously diagnosed head and neck squamous cell carcinomas but de novo primary ESCCs. This study shows the strength of molecular analysis as an adjunct to the histopathologic diagnosis for distinguishing between metastases of prior cancers and primary cancers. Furthermore, these cases imply that presence of BE is not protective with regards to developing ESCC in the lower one third of the esophagus. We suggest that their ESCCs arose from islets of squamous epithelium in BE.
巴雷特食管（BE）是一种具有较高发展为食管腺癌（EAC）风险的癌前病变。EAC 的风险因素与食管鳞状细胞癌（ESCC）的风险因素重叠，但 BE 中 ESCC 却非常罕见。我们报告了两例直接被 BE 包围的 ESCC。两名患者均有头颈部鳞状细胞癌的既往病史，且有饮酒和吸烟史。使用 p63、CK5、CK7 和 CDX2 的免疫组织化学染色，证实这些癌为纯鳞状细胞癌，而非源自 BE 的 EAC 或食管腺鳞癌。通过 TP53 突变和杂合性丢失分析，我们确定 BE 中的 ESCC 不是先前诊断的头颈部鳞状细胞癌的转移，而是新发生的原发性 ESCC。这项研究表明，分子分析作为组织病理学诊断的辅助手段，可用于区分先前癌症的转移和原发性癌症。此外，这些病例表明，BE 的存在并不能预防食管下段发生 ESCC。我们推测，它们的 ESCC 源自 BE 中的鳞状上皮岛。
