Lugol staining and histological evaluation of esophageal mucosa in achalasia.
OBJECTIVE
Esophageal cancer in achalasia is often diagnosed in the advanced stage, which makes for a poor prognosis. Therefore, the aim of this study was to evaluate the macroscopic and histological features of the esophageal mucosa in order to improve the early detection of cancer.


METHODS
We studied the macroscopic features of esophageal mucosa using Lugol's solution and compared them with histological analysis of the entire mucosa in 20 esophagectomy specimens resected for achalasia. Intraepithelial neoplasia, when detected, was selected for DNA ploidy analysis through static cytometry.


RESULTS
Macroscopically, the mucosa showed opacification and/or diffuse irregularities in 19 specimens. Advanced squamous cell carcinoma was diagnosed in 2 cases. Using Lugol, the esophageal mucosa acquired irregular brownish color. Clear unstained areas were circumscribed in 5 esophagi. They were macroscopically defined as ulcer, neoplasia (2 cases) and mucosal irregularities (2 cases). The histological analysis showed ulcer, squamous cell carcinoma (2 cases), Barrett's esophagus and esophagitis, respectively. The histological study of the stained mucosa revealed minute foci of DNA aneuploid intraepithelial neoplasia in 4 cases.


CONCLUSIONS
Macroscopic examination using Lugol failed to identify minute foci of early carcinoma. The stained mucosa does not exclude the esophageal cancer risk in achalasia.
Yamamuro
Elisa Miki
EM
Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil. em.yamamuro@uol.com.br
Cecconello
Ivan
I
Iriya
Kiyoshi
K
El Ibrahim
Roberto
R
Rodrigues
Joaquim Gama
JG
Pinotti
Henrique Walter
HW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000782:Aneuploidy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology; D004396:Coloring Agents; D004931:Esophageal Achalasia / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007454:Iodides; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D011230:Precancerous Conditions / Q000473:pathology; D013194:Staining and Labeling / Q000379:methods*
D004396:Coloring Agents; D007454:Iodides; C010389:Lugol's solution