ACHALASIA-ASSOCIATED SQUAMOUS-CELL CARCINOMA OF THE ESOPHAGUS - FLOW-CYTOMETRIC AND HISTOLOGICAL-EVALUATION

Although the risk of cancer is increased in patients with achalasia, b iomarkers of an increased cancer risk have not been evaluated. In an e sophagectomy specimen of a patient with achalasia-associated squamous cell carcinoma, normal mucosal and caricnomatous samples were systemat ically taken for flow cytometry and histology. The distribution of DNA aneuploidy and dysplasia was mapped within the resected specimen. Fou r of 10 tumor samples and 4 of 16 normal mucosal samples of the esopha gus showed additional aneuploid stem lines. Gastric mucosa only showed diploid DNA histograms. S-phase fraction in normal esophageal samples (7.8% +/- 1.1%) was lower than in dysplastic and carcinomatous sample s (8.8% +/- 2.4%; P = NS). Areas of mild to moderate dysplasia were de tected in the esophageal mucosa adjacent to the neoplasm. This report shows the potential applicability of flow cytometry in the surveillanc e of patients with achalasia. However, prospective endoscopic studies with long follow-up periods are required before flow cytometric and hi stological parameters can be used as biomarkers of an increased cancer risk in achalasia.