Malignant and pre-malignant oesophageal pathology in a South African teaching hospital

Background: South Africa (SA) has one of the highest global incidences of squamous cell carcinoma of the oesophagus (SCC). A decreasing incidence of oesophageal SCC in SA has been suggested. The study aimed to assess whether the incidence of these malignant histopathological subtypes has changed in this setting. Methods: A retrospective review of histopathological reports on pre-malignant and malignant oesophageal lesions over three time periods (TP), namely: 2003­4 (TP1), 2008­9 (TP2) and 2013­14 (TP3) was carried out at Inkosi Albert Luthuli Central Hospital, Durban, South Africa.Results: A total of 1341 specimen reports were retrieved. TP1-3 consisted of 514 (39.3%), 320 (24.5%) and 474 (36.2%) patients respectively. Six hundred and forty-nine patients were male (48.3%), 642 were female (47.8%) and 50 were not specified. i.e. a sex ratio of 1.01:1. The mean age was 60.8 (± 11.8). There were 1197 Black patients (91.5%), 66 Asian (5.1%), 25 White (1.9%), 9 mixed ancestry (0.7%), and 11 of unknown race (0.8%). SCC was the most common cancer 1098 (89.1%) followed by adenocarcinoma (AC) 69 (5.6%). The ratio of SCC to AC remained fairly consistent over the total time period. Seventy-four oesophageal resections were performed with a yearly average resection rate of only 5.6%.Conclusions: SCC is still the most prevalent oesophageal cancer (OC) without an increase in the ratio of AC to SCC. The diagnosis of squamous cell dysplasia is concordant with previously cited rates. Barrett's oesophagitis remains uncommon. Resection rates for OC are low but similar to other South African referring centers

Immunohistochemical Expression of P53; Ebv-Lmpi and Cyclin D1 Proteins in Oesophageal Carcinoma: A Pilot Retrospective Study of 26 Cases

Introduction: The development of oesophageal carcinoma has been attributed to various environmental factors and its incidence varies regionally. The development of this disease is known to occur in recognized histological stages from normal through dysplasia to the malignant stage. Like other cancers; the diagnosis of oesophageal cancer in its premalignant stage would improve the survival. The diagnosis of this cancer on cytomorphology alone is usually done in the late stage of the disease. To be able to diagnose this disease in its early stage; specific tumour markers must be found. The objective of this study was to evaluate p53 tumour suppressor gene protein expression; Epstein-Barr virus latent membrane protein expression and cyclin DI cell cyase protein expression in malignant and normal oesophageal tissues to see whether any variation in their expression in these tissues could be of diagnostic or prognostic value. Methods: 26 archival formalin-fixed paraffin wax embedded tissue blocks of oesphageal carcinoma and 6 of normal oesophagus obtained by endoscopy were studied. 5?m thick tissue sections were cut onto poly-L-Lysine coated microscope slides and dried at 600C for 60 minutes. p53 gene protein expression; EBV-LMPI protein expression and cyclin DI expression were studied immunohisto chemically in these tissue sections. Sections were dewaxed and hydrated to Tris-buffered saline; pH 7.6. Appropriately diluted primary antibodies to p53; EBV-LMPI and Cyclin DI were applied to different sections and incubated overnight at 40OC in a humidity chamber. Sequential applications of other reagents in a three-stage peroxidase antiperoxidase method were applied for chromogen immunoreaction for light microscope visualization. The sections from normal oesophageal tissues were processed with carcinomatous tissues.Results: p53 gene protein was overexpressed in 17 of 26 cases of carcinoma; EBV-LMPI was expressed in 12 of 26 cases of carcinoma; cyclin DI protein was expressed in 14 of the 26 cases of carcinoma; 10 cases of p53 expression were also associated with EBV-LMPI protein expression; 7 cases of p53 protein overexpression did not express EBV-LMPI; 2 cases of EBV-LMPI protein expression did not express p53 protein and 7 cases did not express both p53 and EBV-LMPI proteins. Conclusion: Overexpression of p53 tumour suppressor gene protein in tumour cells of 17 of 26 cases of oesophageal carcinoma while no such expression was demonstrated in normal oesophagus; may have diagnostic and prognostic value. EBV-LMPI expression in tumour cells of 10 of 26 cases of oesophageal carcinoma may also be of value in diagnosis and pathogenesis. Cyclin DI was overexpressed in 14 of the 26 cases and may have diagnostic and prognostic value

Intérêt des marqueurs tumoraux sériques dans les cancers digestifs

Les marqueurs tumoraux sont des composés produits par les cellules cancéreuses ou leur environnement se retrouvant en quantité suffisante dans le sang, les urines et les liquides d'effusion. Les marqueurs les plus utilisés en pathologie digestive sont l'antigène carcino-embryonnaire (ACE), l'alpha foetoproteine (_FP) et le CA19-19. Le but de notre travail est de discuter l'intérêt de ces trois marqueurs dans le dépistage, le suivi et le pronostic des cancers gastriques, pancréatiques, colorectaux et hépatiques.La faible sensibilité et l'existence de faux positifs rendent parfois ces marqueurs impropres à une stratégie de dépistage. Par contre, seul l'_FP a une valeur diagnostique dans les hépato carcinomes pour les populations à haut risque. L'ACE et le CA19-9 ont une bonne sensibilité et une spécificité relative qui leur permettent de suivre l'évolution des cancers digestifs en particulier les cancers colorectaux. Ils constituent les meilleurs marqueurs pour évaluer le pronostic, l'efficacité thérapeutique et pour dépister les récidives de façon précoce. Leur association est justifiée et permet d'atteindre 91% de spécificité et 76% de sensibilité.Devant la place occupée par la biologie dans le diagnostic, le pronostic et le suivi des cancers digestifs par le dosage des marqueurs tumoraux, nous nous devons que de reconnaître tant leurs performances que leurs limites

Oesophageal Carcinoma - a Report of Two Cases and Review of Literature

Background: Oesophageal carcinoma is a malignant epithelial tumour of the oesophagus that arises from the mucosa. It mostly comprises of squamous cell carcinoma and adenocarcinoma of the oesophagus and oesophagogastric junction. It is a relatively uncommon finding. Objective: The objective of this case report is to demonstrate two cases of oesophageal carcinoma seen at the gastroenterology unit of the University of Ilorin Teaching Hospital; Ilorin. Case report: Two cases of oesophageal carcinoma were seen in the last three years. Two Nigerian males of ages 60 and 69 years respectively presented at our centre with a history of progressive dysphagia initially for solids but later involved liquids; and odynophagia. There was associated history of recurrent regurgitation and weight loss. However there was no heartburn; epigastric pain; abdominal swelling; haematemesis or malena. There was significant history of cigarette smoking and intake of alcohol. Barium swallow done; showed shouldering and distal rat tail appearance of the oesophagus. Upper gastrointestinal endoscopy revealed a mass in the oesophagus with evidence of malignant tumour; occluding the lumen of the oesophagus making it impossible to intubate the stomach. Histological examination of the biopsy specimen taken at endoscopy showed adenocarcinoma of the oesophagus. Conclusion: Oesophageal carcinomas are rare findings in Ilorin; Nigeria

Esophageal carcinoma in Seychelles : incidence; diagnosis and treatment

Twenty cases of carcinoma of the esophagus (CE) were registered in Victoria Hospital from 1990 to 1995; representing a crude incidence of 4;7 per 100;000 per year. Diagnosis was confirmed by biopsy in 80 per cent (16 patients) of cases while it was confirmed on postmortem in the remaining 20 per cent (4 cases). Average age at the time of diagnosis was 61.9 years and 90 of cases were men. Histology revealed squamous cell carcinoma in 10 per cent (2 patients). Surgery was performed in 65 per cent (13 patients) of cases and postoperative mortality was 32.5 per cent (4 patients). Among the remaining 9 patients; the survival rate was 77 per cent at 6 months; 44 per cent at one year; 22 per cent at two years; and 11 per cent at 5 years