Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 12, Number 2, April 2019, pages 72-77

Desmoplasia and Detached Papillae in Early Esophageal Adenocarcinoma: A Histologic Study on Endoscopic Submucosal Dissection Specimens

Figure 1. (a) Desmoplasia in an esophageal intramucosal adenocarcinoma (IMAC) (400 ×). (b) Myxoid stromal changes in an esophageal IMAC (100 ×). (c, d) Detached papillae in an esophageal IMAC (100 × and 200 ×).

Figure 2. (a) Barrett’s esophagus-related high-grade dysplasia (HGD) is characterized by confinement of pleomorphic dysplastic cells within the glandular compartment (100 ×). (b) Esophageal intramucosal adenocarcinoma (IMAC) is characterized by penetration of neoplastic cells through the basement membrane (200 ×). (c) Esophageal submucosally invasive adenocarcinoma (SMAC) is characterized by infiltration of neoplastic cells into the submucosa (100 ×).

**Table 1.** Desmoplasia in the Early Esophageal Adenocarcinoma Is Associated With Lymphovascular Invasion
	LVI N (%)	P value
IMAC
Desmoplasia (n = 5)	4 (80)	0.048
Desmoplasia-negative (n = 16)	4 (25)
SMAC		0.24
Desmoplasia (n = 11)	8 (73)
Desmoplasia-negative (n = 4)	1 (25)
IMAC and SMAC combined		0.006
Desmoplasia (n = 16)	12 (75)
Desmoplasia-negative (n = 20)	5 (25)

Table 1. Desmoplasia in the Early Esophageal Adenocarcinoma Is Associated With Lymphovascular Invasion

LVI N (%)

P value

IMAC

Desmoplasia (n = 5)

4 (80)

0.048

Desmoplasia-negative (n = 16)

4 (25)

SMAC

0.24

Desmoplasia (n = 11)

8 (73)

Desmoplasia-negative (n = 4)

1 (25)

IMAC and SMAC combined

0.006

Desmoplasia (n = 16)

12 (75)

Desmoplasia-negative (n = 20)

5 (25)

**Table 2.** Detached Papillae in the Early Esophageal Adenocarcinoma Shows a Trend of Association With Lymphovascular Invasion (LVI) in IMC and SMAC Combined
	LVI N (%)	P value
IMAC
Presence of detached papillae (n = 15)	7 (46.7)	0.34
Absence of detached papillae (n = 6)	1 (16.7)
SMAC		0.24
Presence of detached papillae (n = 11)	8 (72.3)
Absence of detached papillae (n = 4)	1 (25)
IMAC and SMAC combined		0.06
Presence of detached papillae (n = 26)	15 (57.7)
Absence of detached papillae (n = 10)	2 (20)

Table 2. Detached Papillae in the Early Esophageal Adenocarcinoma Shows a Trend of Association With Lymphovascular Invasion (LVI) in IMC and SMAC Combined

LVI N (%)

P value

IMAC

Presence of detached papillae (n = 15)

7 (46.7)

0.34

Absence of detached papillae (n = 6)

1 (16.7)

SMAC

0.24

Presence of detached papillae (n = 11)

8 (72.3)

Absence of detached papillae (n = 4)

1 (25)

IMAC and SMAC combined

0.06

Presence of detached papillae (n = 26)

15 (57.7)

Absence of detached papillae (n = 10)

2 (20)

**Table 3.** Univariate Analysis to Assess Association of Clinicodemographics, ESD Specimen Parameters, and Tumor Characteristics With Lymphovascular Invasion in Early Esophageal Adenocarcinoma
	IMAC (OR: 95% CI)	SMAC (OR: 95% CI)	IMAC and SMAC (OR: 95% CI)
OR: odds ratio; NA: not applicable.
Age	1.09 (0.98 - 1.2), P = 0.1	0.88 (0.73 - 1.1), P = 0.2	1.03 (0.96 - 1.1), P = 0.4
Gender (F/M)	NA	NA	0.53 (0.04 - 6.4), P = 0.6
Largest dimension of ESD specimen	0.5 (0.23 - 1.1), P = 0.09	1.07 (0.58 - 2), P = 0.8	0.73 (0.47 - 1.1), P = 0.2
Average thickness of resection	1.29 (0.64 - 2.6), P = 0.5	NA	1.27 (0.61 - 2.6), P = 0.5
Desmoplasia (yes/no)	12 (1.02 - 141), P = 0.048	8 (0.6 - 110), P = 0.1	9.0 (2.0 - 41), P = 0.005
Detached papillary structures (yes/no)	4.4 (0.4 - 47), P = 0.2	8 (0.6 - 110), P = 0.1	5.45 (0.96 - 31), P = 0.05
Thickness of tumor	2.1 (0.78 - 5.5), P = 0.1	3.9 (0.8 - 18), P = 0.09	2.7 (1.2 - 5.8), P = 0.01
Depth of submucosal invasion	NA	NA	9.7 (0.6 - 148), P = 0.1
Total tumor size	1.01 (0.92 - 1.1), P = 0.8	1.08 (0.9 - 1.3), P = 0.4	1.03 (0.95 - 1.1), P = 0.4
Largest size of carcinoma	1.05 (0.91 - 1.2), P = 0.5	1.2 (0.9 - 1.6), P = 0.2	1.1 (0.98 - 1.2), P = 0.1
Average size of carcinoma	1.03 (0.87 - 1.2), P = 0.7	1.3 (0.9 - 1.9), P = 0.2	1.1 (0.98 - 1.3), P = 0.1
Poor differentiation	1.71 (0.09 - 31.9), P = 0.7	1.60 (0.19 - 13.7), P = 0.7	2.2 (0.44 - 11.2), P = 0.3

Table 3. Univariate Analysis to Assess Association of Clinicodemographics, ESD Specimen Parameters, and Tumor Characteristics With Lymphovascular Invasion in Early Esophageal Adenocarcinoma

IMAC (OR: 95% CI)

SMAC (OR: 95% CI)

IMAC and SMAC (OR: 95% CI)

OR: odds ratio; NA: not applicable.

Age

1.09 (0.98 - 1.2), P = 0.1

0.88 (0.73 - 1.1), P = 0.2

1.03 (0.96 - 1.1), P = 0.4

Gender (F/M)

0.53 (0.04 - 6.4), P = 0.6

Largest dimension of ESD specimen

0.5 (0.23 - 1.1), P = 0.09

1.07 (0.58 - 2), P = 0.8

0.73 (0.47 - 1.1), P = 0.2

Average thickness of resection

1.29 (0.64 - 2.6), P = 0.5

1.27 (0.61 - 2.6), P = 0.5

Desmoplasia (yes/no)

12 (1.02 - 141), P = 0.048

8 (0.6 - 110), P = 0.1

9.0 (2.0 - 41), P = 0.005

Detached papillary structures (yes/no)

4.4 (0.4 - 47), P = 0.2

8 (0.6 - 110), P = 0.1

5.45 (0.96 - 31), P = 0.05

Thickness of tumor

2.1 (0.78 - 5.5), P = 0.1

3.9 (0.8 - 18), P = 0.09

2.7 (1.2 - 5.8), P = 0.01

Depth of submucosal invasion

9.7 (0.6 - 148), P = 0.1

Total tumor size

1.01 (0.92 - 1.1), P = 0.8

1.08 (0.9 - 1.3), P = 0.4

1.03 (0.95 - 1.1), P = 0.4

Largest size of carcinoma

1.05 (0.91 - 1.2), P = 0.5

1.2 (0.9 - 1.6), P = 0.2

1.1 (0.98 - 1.2), P = 0.1

Average size of carcinoma

1.03 (0.87 - 1.2), P = 0.7

1.3 (0.9 - 1.9), P = 0.2

1.1 (0.98 - 1.3), P = 0.1

Poor differentiation

1.71 (0.09 - 31.9), P = 0.7

1.60 (0.19 - 13.7), P = 0.7

2.2 (0.44 - 11.2), P = 0.3

**Table 4.** Multivariable Analysis to Assess if Desmoplasia and/or Detached Papillae Predict Lymphovascular Invasion in Early Esophageal Adenocarcinoma
	IMAC (OR: 95% CI)	IMAC and SMAC (OR: 95% CI)
OR: odds ratio; NA: not applicable.
Desmoplasia (yes/no)	479 (0.5 - 422,810), P = 0.07	8.0 (1.4 - 46), P = 0.02
Largest dimension of ESD specimen	0.3 (0.09 - 0.97), P = 0.04	NA
Thickness of tumor	NA	2.3 (1.0 - 5.4), P = 0.05
Detached papillary structures (yes/no)	NA	4.3 (0.6 - 33), P = 0.16

Table 4. Multivariable Analysis to Assess if Desmoplasia and/or Detached Papillae Predict Lymphovascular Invasion in Early Esophageal Adenocarcinoma

IMAC (OR: 95% CI)

IMAC and SMAC (OR: 95% CI)

OR: odds ratio; NA: not applicable.

Desmoplasia (yes/no)

479 (0.5 - 422,810), P = 0.07

8.0 (1.4 - 46), P = 0.02

Largest dimension of ESD specimen

0.3 (0.09 - 0.97), P = 0.04

Thickness of tumor

2.3 (1.0 - 5.4), P = 0.05

Detached papillary structures (yes/no)

4.3 (0.6 - 33), P = 0.16