TUMORS OF THE ESOPHAGUS AND STOMACH

by

KLAUS J. LEWIN, M.D. FRCPath
Department of Pathology
UCLA School of Medicine
Los Angeles, California 90024

HENRY D. APPELMAN, M.D.
Department of Pathology
The University of Michigan Hospitals
Ann Arbor, Michigan 48109

With the Editorial Collaboration of
Patricia Lewin, M.D.


Table of Contents

1 Introduction and Handling of Esophageal and Gastric Biopsy Resection
  Specimens
  1.1 Biopsies
  1.2 Surgical (Resection) Specimens
  1.3 The TNM Classification and Carcinoma Staging
2 Normal Anatomy, Embryology, and Histology of the Esophagus
  2.1 Embryology
  2.2 Anatomy
    2.2.1 Topographic Relationships and Normal Constrictions of the
          Esophagus
    2.2.2 Esophagus Musculature and Sphincters
  2.3 Blood Supply
    2.3.1 Arterial
    2.3.2 Venous
    2.3.3 Lymphatic Drainage
  2.4 Innervation of the Esophagus
  2.5 Histology
    2.5.1 Mucosa
    2.5.2 Submucosa
3 Benign Epithelial Neoplasms, Salivary Gland-like Tumors, Non-Neoplastic
  Epithelial Proliferations and Other Non-Neoplastic Epithelial
  Tumor-like Conditions
  3.1 Squamous papilloma and Condyloma-like Proliferations
  3.2 Glycogen Acanthosis (Glycogenic Acanthosis)
  3.3 Pseudoepitheliomatous Hyperplasia at the Edges and Bases of Ulcers
  3.4 Cysts
    3.4.1 Development of Cysts and Duplications
    3.4.2 Pseudodiverticulosis (Intramural Diverticulosis)
  3.5 Intramural Epithelial Tumors, Including Salivary Gland-like Tumors
      and Other Epithelial Tumors and Tumor-like Lesions
4 Squamous Cell Carcinoma
  4.1 Usual (Typical) Squamous Cell Carcinoma
  4.2 Squamous Epithelial Dysplasia Including Squamous Cell Carcinoma
      In Situ
  4.3 Superficial Squamous Cell Carcinoma
  4.4 Deeply Invasive Squamous Cell Carcinoma
  4.5 Special Variants of Squamous Cell Carcinoma
    4.5.1 Pseudosarcomatous Squamous Cell Carcinoma (Spindle Cell
          Carcinoma, Polypoid Carcinoma, Carcinosarcoma, Polypoid Tumor)
    4.5.2 Basaloid Squamous Carcinoma (The Commonly Misnamed Adenoid
          Cystic Carcinoma)
    4.5.3 Verrucous Squamous Cell Carcinoma
5 Barrett's Esophagus, Columnar Dysplasia, and Adenocarcinoma of the
  Esophagus
  5.1 Barrett's Esophagus
  5.2 Barrett's Dysplasia
  5.3 Adenocarcinoma of the Esophagus
  5.4 Adenosquamous Carcinoma of the Esophagus and Adenoacanthoma
  5.5 Adenocarcinoma of the Esophagus Unassociated with Barrett's
      Esophagus
    5.5.1 Adenocarcinoma Arising from Heterotopic Gastric Mucosa of
          the Esophagus (the Inlet Patch)
    5.5.2 Adenocarcinoma of Submucosal Glands
    5.5.3 Choriocarcinoma of the Esophagus
6 Mesenchymal Tumors and Tumor-like Proliferations of the Esophagus
  6.1 Leiomyoma
  6.2 Leiomyomatosis
  6.3 Malignant Mesenchymal Tumors: Sarcomas
  6.4 Granular Cell Tumor
  6.5 Fibrovascular Polyps (Giant Fibrovascular Polyps, Fibrolipomas)
      and Lipomas
  6.6 Inflammatory Fibroid Polyps (Inflammatory Pseudotumors)
  6.7 Vascular Tumors
7 Miscellaneous Tumors of the Esophagus
  7.1 Endocrine Tumors
    7.1.1 Carcinoid Tumors
    7.1.2 Small Cell Carcinoma (Small Cell Undifferentiated Carcinoma,
          Oat Cell Carcinoma)
  7.2 Malignant Lymphoma and Plasmacytoma
  7.3 Malignant Melanoma
  7.4 Neoplasms Metastatic to the Esophagus
    7.4.1 Metastatic Carcinoma of the Lung
    7.4.2 Metastatic Melanoma
8 The Stomach: Embryology, Normal Anatomy, and Tumor Derivation
  8.1 Embryology
  8.2 Normal Anatomy
    8.2.1 Gross Anatomy
    8.2.2 Microscopic Anatomy
    8.2.3 Blood Supply
    8.2.4 Lymphatic Supply
    8.2.5 Nerves
  8.3 Classification of Gastric Tumors
9 Non-Neoplastic Tumor-like Lesions, Predominantly Epithelial
  9.1 Gastric Mucosal Polyps
  9.2 Specific Types of Gastric Polyps
    9.2.1 Fundic Gland Polyps and Fundic Gland Polyposis
    9.2.2 Hamartomatous Polyps of the Peutz-Jeghers Type
    9.2.3 Juvenile Polyps
    9.2.4 Gastric Polyps of Cowden's Disease
    9.2.5 Heterotopic or Ectopic Pancreas, Including Adenomyomatous or
          Myoglandular Hamartoma
    9.2.6 Gastric Gland Heterotopia
    9.2.7 Focal Foveolar Hyperplasia (Foveolar Hyperplasia)
    9.2.8 Hyperplastic Polyps
    9.2.9 Polyposis of the Cronkhite-Canada Syndrome
    9.2.10 Other Polyps
  9.3 Giant Rugal Hypertrophies (Giant Folds Diseases, Hyperplastic
      Gastropathies)
    9.3.1 Classification of Giant Folds with or without Associated
          Syndromes
    9.3.2 Normal Variant Giant Folds
    9.3.3 Menetrier's Disease
    9.3.4 Zollinger-Ellison Syndrome
    9.3.5 Lymphocytic Gastritis
    9.3.6 Extensive or Diffuse Neoplastic Infiltrates
    9.3.7 Other Causes of Giant Folds
  9.4 Cysts of the Stomach
    9.4.1 Development Cysts
    9.4.2 Intramucosal Cysts
    9.4.3 Misplaced Gastric Pits in the Submucosa and Muscularis Mucosae:
          Gastritis Cystica Profunda and Gastritis Cystica Polyposa
10 Adenomas
11 Carcinoma of the Stomach
  11.1 Adenocarcinoma of the Stomach
    11.1.1 Prevalence and Incidence
    11.1.2 Pathogenesis
  11.2 Gastric Dysplasia
  11.3 Gastric Carcinoma
  11.4 Morphologic Variants of Gastric Adenocarcinoma
    11.4.1 Undifferentiated Carcinoma with Lymphoid Stroma (Medullary
           Carcinoma Gastric Lymphoepithelioma-like Carcinoma)
    11.4.2 Diffuse Gastric Carcinoma with Gastric Endocrine Cells
    11.4.3 Parietal Cell Carcinoma
    11.4.4 Hepatoid Adenocarcinoma
    11.4.5 Composite Gastric Carcinoma
    11.4.6 Paneth Cell Carcinoma
    11.4.7 Gastric Carcinoma with Rhabdoid Features
    11.4.8 Collision Tumors
  11.5 Adenocarcinoma of the Gastric Cardia and Proximal Stomach
  11.6 Adenocarcinoma in Heterotopic Pancreas
  11.7 Carcinomas with Interspersed Endocrine Differentiation
       (Adenoendocrine Cell Carcinoma, Scirrhous Argyrophil Cell
       Carcinoma)
  11.8 Small Cell (Oat Cell) Carcinoma
  11.9 Adenosquamous and Squamous Cell Carcinoma of the Stomach
  11.10 Adenocarcinoma and Choriocarcinoma
12 Endocrine Cell Proliferations of the Stomach
  12.1 Normal Anatomy of the Gastric Endocrine Cells
  12.2 Endocrine Cell Hyperplasia
    12.2.1 Primary G-Cell Hyperplasia
    12.2.2 Endocrine Cell Hyperplasia Secondary to Gastric Disease
  12.3 Gastric Carcinoid Tumors
  12.4 Small Cell (Oat Cell) Carcinoma
  12.5 Mixed Endocrine and Non-Endocrine Epithelial Tumors
    12.5.1 Carcinoid Tumors with Interspersed Nonendocrine Cells
    12.5.2 Adenocarcinoma with Interspersed Endocrine Cells
    12.5.3 Composite Glandular-Endocrine Cell Carcinomas and Gastric
           Collision Tumors
    12.5.4 Poorly Differentiated (Signet-Ring Cell) Carcinoma with
           Interspersed Endocrine Cells
13 Lymphoproliferative Disorders of the Stomach
  13.1 Lymphoma
  13.2 Secondary Malignant Lymphomas
  13.3 Gastric Lymphoid Hyperplasia (Pseudolymphoma)
  13.4 Gastric Involvement in Leukemia
  13.5 Solitary Plasmacytomas
  13.6 Angiocentric Lymphoproliferative Lesion (Lymphomatoid
       Granulomatosis) Involving the Stomach
  13.7 Mycosis Fungoides Involving the Stomach
14 Mesenchymal Tumors and Tumor-like Proliferations
  14.1 Common Stromal Tumors Composed of Undifferentiated, Minimally
       Differentiated, or Peculiarly Differentiated Cells/Leiomyomas
       and Leiomyosarcomas
    14.1.1 Use of Intraoperative Consultation, Including Frozen Section,
           in the Management of Gastric Stromal Tumors
    14.1.2 Procedure for Pathologic Examination
  14.2 Tumors Composed of Mature Smooth Muscle Cells (Typical Leiomyomas)
  14.3 Tumors of Adipose Tissue
    14.3.1 Lipomas
    14.3.2 Liposarcomas
  14.4 Neural Tumors
    14.4.1 Common Gastric Stromal Tumors That May Be Neural Neoplasms,
           Including Gastric Autonomic Nerve (GAN) Tumors
    14.4.2 Neuroma/Ganglioneuroma and Neurofibroma with and without Von
           Recklinghausen's Multiple Neurofibromatosis and Multiple
           Endocrine Neoplasia Type II
    14.4.3 Schwannoma
    14.4.4 Granular Cell Tumor
    14.4.5 Gangliocytic Paraganglioma
  14.5 Tumors of Blood and Lymphatic Vessels
    14.5.1 Glomus Tumors
    14.5.2 Hemangioma, Lymphangioma, and Vascular Malformations
    14.5.3 Angiosarcoma and Hemangioendothelioma
    14.5.4 Kaposi's Sarcoma
    14.5.5 Hemangiopericytoma
  14.6 Other Tumors
  14.7 Tumor-like Lesions
    14.7.1 Inflammatory Fibroid Polyp (Eosinophilic Granuloma, Vanek's
           Tumor, Granuloblastoma, Fibroma with Eosinophilic
           Infiltration, Submucosal Granuloma with Eosinophilic
           Infiltration)
    14.7.2 Xanthelasma (Xanthoma, Lipid Island)
15 Miscellaneous Tumors
  15.1 Germ Cell Tumors
    15.1.1 Teratoma
    15.1.2 Choriocarcinoma and Yolk Sac (Embryonal) Carcinoma
  15.2 Carcinosarcoma (Sarcomatoid Carcinoma, Pseudosarcomatous
       Carcinoma)
  15.3 Metastatic Neoplasms
    15.3.1 Metastatic Melanoma
    15.3.2 Metastatic Carcinoma of the Breast
    15.3.3 Metastatic Carcinoma of the Lung
  15.4 Other Tumors and Tumor-like Lesions
16 Index

Back