Dysplasia in the human esophagus: clinicopathological study on 500 esophagi at autopsy

To clarify the relation between esophageal carcinoma and dysplasia, the pathology and epidemiology of 500 cases where clinically overt esophageal carcinoma had not been the direct cause of death were studied at autopsy. There were 297 men and 203 women. Four hundred and eighty-five patients had had malignant disease, of which 91 fulfilled the criteria for multiple primary malignancies. For all cases, cigarette and drinking habits were examined in patient records. All the esophagi were examined at autopsy by microscopy. Carcinoma in situ was found in six cases (1.2%). Dysplasia was observed in 73 (14.6%) and was graded mild in 58, moderate in 25 and severe in seven. The incidence of dysplasia was frequent in men than in women. Carcinoma in situ and severe dysplasia were more frequent where there was a history of habitual smoking and drinking, and were often associated with multiple primary cancers, mainly in the head and neck region. Predisposing factors for high grade dysplasia of the esophagus are gender, smoking, drinking, head and neck cancer and multiple primary cancers, corresponding to those of clinical esophageal carcinoma.