Histopathological Evaluation of Esophageal Carcinomas following Neoadjuvant Chemo/Chemo Radiotherapy

Abstract

Esophageal carcinoma is an aggressive malignancy with multifactorial etiology. Preoperative chemo/chemoradiotherapy followed by surgery currently represents the standard approach to locally advanced esophageal carcinoma. Assessment of tumor response to neoadjuvant treatment is best done by histopathological examination of the resected specimen of esophageal carcinoma. Aim of the study is macroscopic and microscopic evaluation of the esophageal carcinomas following neoadjuvant chemo/chemoradiotherapy in the neoplastic and adjacent non neoplastic tissue. Lymph nodes were evaluated for similar features. Also evaluation of tumor regression was done using Becker’s grading system. It is a prospective and retrospective observational study of fifty esophageal carcinoma cases (including carcinoma of gastro esophageal junction). In the diagnosed cases of esophageal carcinomas full clinical information and relevant radiological findings were noted down. Clinicopathological variables were evaluated for their relationship with tumor regression status. Gross findings of the surgically resected specimens and microscopic findings for various therapy related changes were noted down.  There were 18 males and 32 females (M: F:: 0. 56 : 1  ) with age ranging from 25 yrs to 70 yrs (median age is 48 yrs).Squamous cell carcinoma  and adenocarcinoma were 37 and 11 cases respectively besides single case of high grade neuroendocrine tumor and  adenosquamous carcinoma each. 40 % cases achieved complete tumor regression. Histological grading of post chemotherapy specimens were compared with the initial biopsy. Tumor response to neoadjuvant treatment is prognostically significant as described in many studies. Therefore it can be concluded that response to neoadjuvant therapy can be evaluated by histopathological examination of the resected specimen of esophageal carcinoma. Proper macroscopic and microscopic evaluation of such specimens are difficult and challenging task especially in cases of examination of specimens of esophageal carcinoma with good response to chemo/chemoradiation.