A 55-year-old man undergoes an esophagogastroduodenoscopy for a 4-month history of progressive solid-food dysphagia and a 6-kg (13.2-lb) weight loss. He has a 30-pack-year smoking history and consumes several alcoholic beverages daily. Endoscopy reveals an irregular, friable, and ulcerated mass in the middle third of the esophagus. Multiple mucosal biopsies are obtained. The physician suspects squamous cell carcinoma based on the patient's risk factors and tumor location. Which of the following histopathologic biopsy findings would confirm this specific diagnosis? (Select all that apply)
- Presence of well-formed keratin pearlsAnswer
- BProliferation of atypical mucin-producing glands
- Prominent intercellular bridges between malignant cellsAnswer
- DSignet ring cells infiltrating the lamina propria
- ESmall round blue cells with stippled chromatin
Answer
The correct findings are the presence of well-formed keratin pearls and prominent intercellular bridges between malignant cells.
The clinical presentation of an ulcerated mass in the middle third of the esophagus in a patient with a heavy smoking and alcohol history is classic for esophageal squamous cell carcinoma. Establishing this diagnosis definitively requires recognizing the hallmark histopathologic features of squamous differentiation on biopsy. These include the presence of keratin pearls (circular, eosinophilic whorls of keratinized cells) and distinct intercellular bridges (desmosomes connecting adjacent cells). Both of these findings confirm a squamous cell lineage.
Step-by-Step Solution
Key Concept
Histopathologic identification of esophageal squamous cell carcinoma involves recognizing distinct features of squamous differentiation, primarily keratin pearls and intercellular bridges.