Tumours of the oesophagus (Robbins pp 783)

Benign tumours

These tumours of the oesophagus are mesenchymal in origin and lie within the oesophageal wall. Most common are tumours of the smooth muscle of the oesophageal wall ≫ leiomyomas. Polyps can also occur. If polyps contains lipid material ≫ lipoma. If they contain vascular material ≫ vascular polyps. Squamous papilloma can also occur. Benign tumours of the nerves ≫ neurofibroma and all can also occur.

Malignant tumours

Most commonly squamous cell carcinoma & adenocarcinoma of the oesophagus. Secondary tumours can also occur. Other tumours are rare and can occur, such as: malignant melanoma, carcino-sarcoma, adenoid cystic carcinoma.

Squamous cell carcinoma

• Risk factors: Male>Female, Alcohol, Tobacco, prolonged oesophagitis, Barett’s oesophagitis, Dietary factors: food carcinogens combined with nutritional deficiencies. Genetic component is not really that great.
• Location: 50% - middle 1/3, 30% – lower 1/3, 20% - upper 1/3.
• Patterns of growth: Three types seen,
  
• 1) protruded (60%) – lesion is exophytic and protrudes into the lumen,
  
• 2) diffuse infiltration of the oesophageal wall and no where else. This causes thickening, rigidity and narrowing of lumen.
  
• 3) excavated lesions where the cancer becomes necrotic and ulcerates through the oesophageal wall, and may even penetrate into the respiratory tree or aorta.

Adenocarcinomas

• Common in lower 1/3 of the oesophageal and associated with Barrett’s mucosa.
  
• Histopathology: Microscopically, most tumours are mucin producing and glandular.

Category: Pathology Notes