Abstract
With regard to the esophagus, the term “squamous dysplasia” has been used in European countries, the United States, and China, while its use is controversial in Japan. Recently, “low-grade intraepithelial neoplasia” and “high-grade intraepithelial neoplasia” have been used as inclusive terms for dysplasia and carcinoma in situ in the World Health Organization classification. Endoscopically, it is often difficult to identify squamous intraepithelial neoplasia by conventional endoscopy, but application of iodine is useful for the diagnosis of such a lesion. In addition, new types of endoscopic techniques, including magnifying endoscopy, narrow-band imaging (NBI), and endocytoscopy are helpful to detect squamous intraepithelial neoplasia. NBI is very useful for identifying the intrapapillary capillary loop pattern. Regarding the pathological criteria of squamous dysplasia and squamous cell carcinoma, the views of Japanese and Western pathologists have differed significantly. Before the term “intraepithelial neoplasia” was introduced, severe dysplasia as diagnosed by Western pathologists was in fact the same as squamous cell carcinoma in situ or noninvasive carcinoma as diagnosed by Japanese pathologists. This problem has been solved by the introduction of the Vienna classification; however, there are still some issues that need to be resolved. One of them is the presence of basal layer type squamous cell carcinoma in situ, which is often underdiagnosed as lowgrade intraepithelial neoplasia by Western pathologists. Endoscopic treatments such as endoscopic mucosal resection and endoscopic submucosal dissection have recently become possible choices for squamous intraepithelial neoplasia; however, these techniques are not in widespread use in the West. We believe that a consensus meeting between Japanese and Western pathologists as well as endoscopists should be held promptly to reach a common ground for the nomenclature.
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Siewert JR, Stein HJ. Barrett’s cancer: indication, extent, and results of surgical resection. Semin Surg Oncol 1997;13:245–52.
Ban S, Mino M, Nishioka NS, Puricelli W, Zukerberg LR, Shimizu M, et al. Histopathologic aspects of photodynamic therapy for dysplasia and early adenocarcinoma arising in Barrett’s esophagus. Am J Surg Pathol 2004;28:1466–73.
Iacobuzio-Donahue CA, Montgomery E, Goldblum JR. Gastrointestinal and liver pathology. Philadelphia: Churchill Livingstone; 2005. p. 38–65.
Day DW, Jass JR, Price AB, Shepherd NA, Sloan JM, Talbot IC, et al. Morson and Dawson’s gastrointestinal pathology. Fourth ed. Berlin: Blackwell Science; 2003. p. 59–84.
Chatelain D, Fléjou JF. High-grade dysplasia and superficial adenocarcinoma in Barrett’s esophagus: histological mapping and expression of p53, p21 and Bcl-2 oncoproteins. Virchows Arch 2003;442:18–24.
Nagamatsu M, Mori M, Kuwano H, Sugimachi K, Akiyoshi T. Serial histologic investigation of squamous epithelial dysplasia associated with carcinoma of the esophagus. Cancer 1992;69:1094–8.
Yasuda M, Kuwano H, Watanabe M, Toh Y, Ohno S, Sugimachi K. p53 expression in squamous dysplasia associated with carcinoma of the oesophagus: evidence for field carcinogenesis. Br J Cancer 2000;83:1033–8.
Lu N, Hu N, Li WJ, Roth MJ, Wang C, Su H, et al. Microsatellite alterations in esophageal dysplasia and squamous cell carcinoma from laser capture microdissected endoscopic biopsies. Cancer Lett 2003;189:137–45.
Zhang W, Wang L, Chang A, Jin Y, Rao J. Immunohistochemical analysis of cyclooxygenase-2 expression in premalignant and malignant esophageal glandular and squamous lesions in Cixian, China. Cancer Detect Prev 2003;27:243–9.
Gabbert HE, Shimoda T, Hainaut P, Nakamura Y, Field JK, Inoue H. Squamous cell carcinoma of the oesophagus. In: Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumours. Pathology and genetics. Tumours of the digestive system, Lyon: IARC Press; 2000. p. 8–19.
Geddert H, Kiel S, Heep HJ, Gabbert HE, Sarbia M. The role of p63 and deltaNp63 (p40) protein expression and gene amplification in esophageal carcinogenesis. Hum Pathol 2003;34:850–6.
Bax DA, Haringsma J, Einerhand AWC, van Dekken H, Blok P, Siersema PD, et al. MUC4 is increased in high grade intraepithelial neoplasia in Barrett’s oesophagus and is associated with a proapoptotic Bax to Bcl-2 ratio. J Clin Pathol 2004;57:1267–72.
Japanese Society for Esophageal Diseases. Guideline for the clinical and pathologic studies on carcinoma of the esophagus (in Japanese). 10th edition. Tokyo: Kanehara; 2007.
Japanese Society for Esophageal Diseases. Guidelines for diagnosis and treatment of esophageal carcinoma (in Japanese). 2nd ed. Tokyo: Kanehara; 2007.
Cotran RS, Kumar V, Robbins SL. Neoplasia. In: Robbins pathologic basis of disease. 5th ed. Philadelphia: Saunders; 1994. p. 241–303.
Watanabe H, Jass JR, Sobin LH. World Health Organization. International histological classification of tumours. Histological typing of oesophageal and gastric tumours. 2nd ed. New York: Springer; 1990. p. 1–18.
Odze RD, Goldblum JR, Crawford JM. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Philadelphia: Saunders; 2004. p. 381–408.
Fenoglio-Preiser CM, Noffsinger AE, Stemmermann GN, Lantz PE, Isaacson PG. Gastrointestinal pathology. An atlas and text. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 86–109.
Round-table talk: squamous dysplasia—how should we think about it? (in Japanese) Stomach and Intestine 1996;31:762–78.
Round-table talk: regarding esophageal squamous dysplasia—based on results of case discussions (in Japanese). Stomach and Intestine 2007;42:219–38.
Watanabe G, Ajioka Y, Kobayashi M, Aruga Y, Watanabe Y, Nishikura K. Pathological diagnosis of “dysplasia” in the esophageal squamous epithelium (in Japanese with English abstract). Stomach and Intestine 2007;42:129–35.
Takubo K. Pathology of the esophagus. An atlas and textbook. 2nd ed. Tokyo: Springer; 2007. p. 145–90.
Lewin KJ, Appelman HD. Atlas of tumor pathology, Tumors of the esophagus and stomach. Third series. Washington, D.C.: AFIP; 1996. p. 43–97.
Rosai J. Rosai and Ackerman’s surgical pathology. 9th ed. Edinburgh: Mosby; 2004. p. 615–47.
Wei WQ, Abnet CC, Lu N, Roth MJ, Wang GQ, Dye BA, et al. Risk factors for oesophageal squamous dysplasia in adult inhabitants of a high risk region of China. Gut 2005;54:759–63.
Dry SM, Lewin KJ. Esophageal squamous dysplasia. Semin Diagn Pathol 2002;19:2–11.
Ishii I, Murakami J, Notohara K, Cullings HM, Sasamoto H, Kambara T, et al. Oesophageal squamous cell carcinoma may develop within a background of accumulating DNA methylation in normal and dysplastic mucosa. Gut 2007;56:13–9.
Mori M, Adachi Y, Matsushima T, Matsuda H, Kuwano H, Sugimachi K. Lugol staining pattern and histology of esophageal lesions. Am J Gastroenterol 1993;88:701–5.
Dawsey SM, Fleischer DE, Wang GQ, Zhou B, Kidwell JA, Lu N, et al. Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus in Linxian, China. Cancer 1998;83:220–31.
Kumagai Y, Inoue H, Nagai K, Kawano T, Iwai T. Magnifying endoscopy, stereoscopic microscopy, and the microvascular architecture of superficial esophageal carcinoma. Endoscopy 2002;34:369–75.
Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo S. Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc 2004:59:288–95.
Inoue H, Sasajima K, Kaga M, Sugaya S, Sato Y, Wada Y, et al. Endoscopic in vivo evaluation of tissue atypia in the esophagus using a newly designed integrated endocytoscope: a pilot trial. Endoscopy 2006;38:891–5.
Inoue H, Kaga M, Sato Y, Sugaya S, Wakamura K, Satodate H, et al. Endoscopic diagnosis of tissue atypia (EA) in esophageal squamous epithelium—IPCL pattern classification and ECA classification (in Japanese with English abstract). Stomach and Intestine 2007;42:161–71.
Inoue H. Magnification endoscopy in the esophagus and stomach. Dig Endosc 2001;13 Suppl:S40–1.
Ciocirlan M, Lapalus MG, Hervieu V, Souquet JC, Napoléon B, Scoazec JY, et al. Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 2007;39:24–9.
Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 2006;4:688–94.
Arima M, Tada M, Arima H. Evaluation of microvascular patterns of superficial esophageal cancers by magnifying endoscopy. Esophagus 2005;2:191–7.
Shimizu M, Ban S, Odze RD. Squamous dysplasia and other precursor lesions related to esophageal squamous cell carcinoma. Gastroenterol Clin N Am 2007;36:797–811.
Tajima Y, Nakanishi Y, Tachimori Y, Kato Y, Watanabe H, Yamaguchi H, et al. Significance of involvement by squamous cell carcinoma of the ducts of esophageal submucosal glands. Analysis of 201 surgically resected superficial squamous cell carcinomas. Cancer 2000;89:248–54.
Schlemper RJ, Dawsey SM, Itabashi M, Iwashita M, Kato Y, Koike M, et al. Differences in diagnostic criteria for esophageal squamous cell carcinoma between Japanese and Western Pathologists. Cancer 2000;88:996–1006.
Vieth M, Stolte M. Pathology of early upper GI cancers. Best Pract Res Clin Gastroenterol 2005;19:857–69.
Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. The Vienna classification of gastrointestinal neoplasia. Gut 2000;47:251–5.
Shimizu Y, Kato M, Yamamoto J, Ono Y, Katsurada T, Ono S, et al. Histologic results of EMR for esophageal lesions diagnosed as high-grade intraepithelial squamous neoplasia by endoscopic biopsy. Gastrointest Endosc 2006;63:16–21.
Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002;51:130–1.
Lambert R, Hainaut P, Parkin DM. Premalignant lesions of the esophagogastric mucosa. Semin Oncol 2004;31:498–512.
Stolte M. The new Vienna classification of epithelial neoplasia of the gastrointestinal tract: advantages and disadvantages. Virchows Arch 2003;442:99–106.
Lauwers GY, Ban S, Mino M, Ota S, Matsumoto T, Arai S, et al. Endoscopic mucosal resection for gastric epithelial neoplasms: a study of 39 cases with emphasis on the evaluation of specimens and recommendations for optimal pathologic analysis. Mod Pathol 2004;17:2–8.
Makuuchi H. Endoscopic mucosal resection for mucosal cancer in the esophagus. Gastrointest Endosc Clin N Am 2001;11:445–58.
Gotoda T. Endoscopic resection for premalignant and malignant lesions of the gastrointestinal tract from the esophagus to the colon. Gastrointest Endosc Clin N Am 2008;18:435–50.
Takubo K, Aida J, Sawabe M, Kurosumi M, Arima M, Fujishiro M, et al. Early squamous cell carcinoma of the oesophagus: the Japanese viewpoint. Histopathology 2007;51:733–42.
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Shimizu, M., Nagata, K., Yamaguchi, H. et al. Squamous intraepithelial neoplasia of the esophagus: past, present, and future. J Gastroenterol 44, 103–112 (2009). https://doi.org/10.1007/s00535-008-2298-y
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DOI: https://doi.org/10.1007/s00535-008-2298-y