title: Prevalence and prognostic significance of neuroendocrine cells in esophageal adenocarcinoma.
abstract: Neuroendocrine differentiation is common in adenocarcinomas of the stomach and colon and may be associated with a slightly better prognosis in gastric adenocarcinoma. We studied neuroendocrine differentiation in esophageal adenocarcinomas and associated Barrett's esophagus (BE) to determine association with patient outcome. Fifty-eight cases of esophageal adenocarcinoma (15 biopsies, 43 resections) from 52 patients were stained with a monoclonal antibody to chromogranin (CG). Medical records were reviewed for tumor stage, response to therapy, and patient survival. Thirty-two patients received radiation and chemotherapy, and four received radiation. Twelve of 58 (20.7%) esophageal adenocarcinomas contained scattered CG-positive cells. Tumors with CG-positive cells were moderately to poorly differentiated, and many consisted of large cribriform glands, similar to intestinal-type adenocarcinomas. One case of small cell carcinoma of the esophagus was weakly CG positive; another was negative. Neuroendocrine differentiation was retained in lymph node metastases in two cases but lost in three other cases. In 10 CG-negative primary tumors, lymph node metastases were also negative. For five of six patients with paired biopsy/resection specimens, no CG-positive cells were seen in either specimen; one patient had CG-positive cells only in the resection. There was no difference in tumor stage at surgery or survival time between CG-positive and CG-negative tumors. BE was present in 34 cases and contained CG-positive cells in 21 of 34 (61.8%). Low-grade dysplasia contained CG-positive cells in 11 of 14 cases (78.6%) and high-grade dysplasia in 3 of 6 cases. Fourteen of 21 (66.7%) adenocarcinomas associated with CG-positive BE were negative for CG. In summary, neuroendocrine differentiation is common in BE and is retained in low- and high-grade dysplasia but is usually lost in esophageal adenocarcinoma. The presence of scattered neuroendocrine cells does not affect patient outcome.
authors.affiliation: Department of Pathology, Nashville Veterans Affairs Medical Center, Tennessee, USA.
authors.forename: K
authors.initials: K
authors.lastname: Hamilton
authors.forename: A
authors.initials: A
authors.lastname: Chiappori
authors.forename: S
authors.initials: S
authors.lastname: Olson
authors.forename: J
authors.initials: J
authors.lastname: Sawyers
authors.forename: D
authors.initials: D
authors.lastname: Johnson
authors.forename: K
authors.initials: K
authors.lastname: Washington
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology*; D001471:Barrett Esophagus / Q000378:metabolism / Q000473:pathology; D018278:Carcinoma, Neuroendocrine / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology*; D002454:Cell Differentiation; D002864:Chromogranins / Q000032:analysis; D004938:Esophageal Neoplasms / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D009367:Neoplasm Staging; D009490:Neurosecretory Systems / Q000473:pathology; D015995:Prevalence; D011379:Prognosis; D016019:Survival Analysis; D013714:Tennessee / Q000453:epidemiology
chemical_list: D002864:Chromogranins