A Case of Poorly Differentiated Adenocarcinoma of the Esophagus with HLA-DR Antigen Expression in Lymphoid Stroma

Shingo Mitomo, Takeshi Iwaya, Kenichiro Ikeda, Yusuke Kimura, Keisuke Koeda, Hisataka Fujiwara, Toshimoto Kimura, Noriyuki Uesugi*, Chihaya Maesawa** and Go Wakabayashi

Department of Surgery and Division of Pathology, Central Clinical Laboratory* and Department of Pathology II**, Iwate Medical University School of Medicine

A 56-year-old man with dysphagia and found in endoscopic examination to have an ulcerative lesion in the inferior thoracic esophagus was diagnosed with adenocarcinoma from a biopsy specimen, necessitating esophagectomy. Histologically, the resected tumor showed poorly differentiated adenocarcinoma, which presented with features of medullary carcinoma with lymphoid stroma. This particular histological type of carcinoma, such as breast and gastric, has been reported to be related to better prognosis and to be associated with Epstein-Barr virus (EBV) infections in gastric carcinomas. Cases of esophageal cancer are rare, however, and their pathogenesis remains to be clearfied. No positive signs of EBV were detected in tumor cells in our case. Immunohistochemically, the expression of HLA-DR antigen was evident in cancer cells, suggesting that HLA-DR antigen expression in esophageal cancer with lymphoid infiltration is thought to be associated with long-time survival. The patient has survived for more than 12 months after surgery with no signs of recurrence.

Key words
esophageal cancer, lymphoid stroma, HLA-DR antigen

Reprint requests
Shingo Mitomo Department of Surgery, Iwate Medical University School of Medicine
19-1 Uchimaru, Morioka, 020-8505 JAPAN

Accepted
December 19, 2007

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