Barrett's mucosa in conjunction with squamous carcinoma of the esophagus

Fifty esophagectomies (32 specimens with squamous cell carcinoma and 18 with adenocarcinoma) were reviewed for the presence of Barrett's mucosa. The whole resected specimens were cut, and a total of 1677 blocks (measuring up to 4.0 x 0.5 cm) were obtained. In resections with squamous cell carcinoma, a mean of 33.6 sections (range, 16 to 55 sections) were excised, and in those with adenocarcinomas, a mean of 33.4 sections (range, ten to 60 sections) were cut. Barrett's mucosa (without or with dysplasia) was present in all 18 specimens with an adenocarcinoma (100%) and in 13 of the 32 specimens (40.6%) with squamous cell carcinoma. In ten of the 13 specimens with squamous cell carcinoma, adjacent areas with high-grade squamous cell dysplasia were found. The squamous cell carcinoma and/or the adjacent squamous cell dysplasia were found separated from the Barrett's mucosa by normal squamous epithelium, supporting the view that these two lesions are not related to one another. Early clinical and experimental data showed that squamous cell dysplasia antedated the development of squamous cell carcinoma in that organ. One possible suggestive of these findings is that the detection of a Barrett's esophagus (without or with dysplasia) should prompt the endoscopist also to examine carefully the rest of the esophagus to exclude mucosal alterations possibly connected with squamous cell carcinogenesis in that organ.