Prognosis

Prognosis of oesophageal cancer is poor (5-year survival 5-10% in the Western hemisphere) and relates to tumour type (small cell carcinoma, basaloid carcinoma are adverse), grade (equivocal), diameter (in superficial carcinoma), but most importantly, depth of invasion and stage. Nodal status and whether the longitudinal and circumferential radial margins are positive (55% recurrence rate, 25% 5-year survival) or negative (13% recurrence rate, 47% 5-year survival in one series) are important prognostic variables. Early oesophageal squamous cell carcinoma does significantly better than advanced disease. Early (pT1) adenocarci-noma may show less recurrence than equivalent squamous lesions but, for the majority of cases, although adenocarcinoma may have slightly better overall 5-year survival (25%), the two main pathological types have little differential influence on prognosis.

9. OTHER MALIGNANCY

Lymphoma/leukaemia

— rare. More usually secondary to systemic/nodal disease.

— primary lymphoma is large B cell in type.

— consequences of immunosuppression due to the tumour or its treatment may be seen, e.g. cytomegalovirus, herpetic or fungal oesophagitis.

Leiomyoma/ leiomyosarcoma/GISTs

— leiomyomas greatly outnumber leiomyosarcomas (malignancy: >5 cm diameter, necrosis, mitoses >5/50 high-power fields, cellular atypia, infiltrative margins). Most are small, identified by endoscopy and arise from the muscularis mucosae or inner muscularis propria. They can be multiple, intraluminal or intramural. Oesophageal gastrointestinal stromal tumours (GISTs) are rare (CD117/CD34 positive, desmin negative) and potentially malignant with liver metastases.

Sarcoma

— rare. Ninety percent are leiomyosarcoma (desmin, h-caldesmon positive).

— embryonal rhabdomyosarcoma (childhood: desmin/myo Dl/myogenin positive).

— Kaposi's sarcoma (AIDS): human herpes virus 8 (HHV 8) positive by polymerase chain reaction.

— synovial sarcoma: children/adults, polypoid mass in upper oesophagus.

— exclude the more common possibility of a spindle cell carcinoma (polypoid carcinoma/carcinosarcoma) with cytokeratin-positive spindle cells and varying degrees of homologous or heterologous mesenchymal differentiation.

Others

— rare: granular cell tumour (S100 positive, overlying pseudoepithe-liomatous hyperplasia), carcinoid tumour (chromogranin, synapto-physin, CD56 positive).

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