Squamous mucosal alterations in esophagectomy specimens from patients withend-stage achalasia

Achalasia is an esophageal motor disorder in which the primary morphologic changes are found in the myenteric plexus. However, a number of secondary a lterations are characteristically found in esophagectomy specimens, includi ng the mucosa. In addition, these patients are at increased risk of develop ing esophageal squamous cell carcinoma. We studied the squamous mucosal alt erations in 35 esophagectomy specimens from patients with end-sta-e achalas ia and compared them with those found in the squamous mucosa near the esoph agogastric junction from pediatric autopsies (less than or equal to 18 year s) from patients with no known esophageal disease. A representative block w as immunostained for p53 (DO7), CD3, and CD20. p53 immunoreactivity was gra ded as follows: 0 = no staining; 1+ = rare basal cell staining; 2+ = extens ive basal cell staining; 3+ = suprabasilar staining. Intraepithelial lympho cyte counts were performed by counting five high power fields (HPF) and cal culating an average/HPF. Ages of achalasia patients at esophagectomy ranged from 21 to 78 years (mean 56 years), including 20 men and 15 women. Diseas e duration ranged from 1 to 44 years (mean 17 years). In all cases the squa mous mucosa from achalasia patients was markedly hyperplastic with papillom atosis and basal cell hyperplasia. p53 staining in the squamous mucosa from achalasia patients was significantly more common than in controls (32 of 3 5 [91%] vs 1 of 17 [6%]; p <0.05). In all achalasia cases CD3+ cells far ou tnumbered CD20+ cells. There was a significantly greater number of CD3+ cel ls in achalasia cases (range 32-239/HPF; mean 107/HPF) compared with contro ls (range 0.8-12/HPF; mean 6/HPF) (p <0.05). In conclusion, the squamous mu cosa in esophagectomy specimens from patients with end-stage achalasia show s significant alterations including marked squamous hyperplasia, an increas ed frequency of p53 immunoreactivity, and increased numbers of CD3+ cells w hen compared with controls. These changes may be related to the increased r isk of squamous cell carcinoma in these patients.