<p>Clinicopathological features and outcomes of esophageal lesions containing a basal layer type squamous cell carcinoma component</p>

Abstract

PurposeBasal layer type squamous cell carcinoma (BLSCC) is a unique type of squamous cell carcinoma (SCC), characterized by high-grade dysplastic cells occupying the lower half of the epithelium. So far, such special lesions do not seem to attract much attention. The aim of this study was to investigate the clinicopathological features and prognosis of esophageal squamous carcinoma lesions with a BLSCC component.Materials and methodsBetween January 2011 and January 2018, 96 patients with esophageal squamous cell carcinoma underwent endoscopic submucosal resection in our hospital were retrospectively analyzed. Patients were divided into BLSCC or typical SCC groups according to the presence or absence of a BLSCC component. The endoscopic findings were compared between the two groups. Furthermore, patients were followed up until October 2018 to compare recurrence rates.ResultsBLSCC components were detected in 32 (33.3%, 32/96) lesions. Among them, 13 (40.62%, 13/32) were BLSCC predominant. The intraepithelial papillary capillary loops of 7 pure BLSCC showed type B1 under narrow-band imaging. Single-factor and multivariate analyses indicated that five or more independently scattered, deep-stained spots in iodine-unstained areas were significantly predictive of the presence of BLSCC components (OR=4.837, P=0.015). All patients of typical SCC group survived, but one of BLSCC group died for distant metastases during the follow-up period. The 1-year cumulative recurrence rate (CRR) of BLSCC group were 3.4%, lower than that of typical SCC group (7.1%). Although no significant difference of CRR was seen between the two groups (P>0.05), the 2-year CRR of BLSCC group increased to 11.9%, being higher than that of typical SCC group (7.1%).ConclusionThe presence of multiple, scattered stained spots in iodine-unstained areas was predictive of BLSCC components. Such lesion should be treated actively and subject to a more rigorous follow-up protocol due to a higher likelihood of late recurrence.

Mechanistic model: Analysis of diffusion dynamics of Lugol’s chromoendoscopy in Basal layer-type squamous cell carcinoma in situ via Euler’s method and Law of mass action

“…In other words, if BLSCC has enough glycogen granules and fewer IPCL, Lugol’s Chromendoscopy does not work. The two factors are consistent with endoscopic characteristics (Zhuang, Chen et al 2019)and histology structure in BLSCC.…”

“…We removed the cell nucleus and other organelles for the same principle because there is no relationship between them and iodine diffusion. As mentioned above, Basal layer-type squamous cell carcinoma in situ is High-grade dysplasia, restricted to the basal cell layer(Zhuang, Chen et al 2019) (Figure D). In our model, we use a black cube for BLSCC(Figure E).…”

“…The latter implies that high-grade dysplasia is not more than half of the epithelium(Figure D) and brings many difficulties in its diagnose and treatment(Sarbia, Wolfer et al 2015). Japanese pathologists called it Basal layer-type squamous cell carcinoma in situ(Zhuang, Chen et al 2019) (BLSCC).compare with the conventional carcinogenesis way of typical SCC, BLSCC infiltrates directly to lamina propria and do not involve in the upper half of the epithelium. Chromoendoscopy with iodine staining may be more reliable than narrow-band imaging in detecting BLSCC because the latter is harder to detect irregularly shaped multiform lesions and absence of homogenization(Ishihara, Takeuchi et al 2010, Goda, Dobashi et al 2015, Zhuang, Chen et al 2019).…”

“…Basal layer-type squamous cell carcinoma in situ had a higher recurrence rate(Zhuang, Chen et al 2019), so BLSCC’s recurrence rate implied some limitations of Lugol’s Chromendoscopy for detecting a demarcation line between normal mucosa and cancerous lesion. More interesting, For BLSCC, scattered stained spots in Iodine unstained areas(Zhuang, Chen et al 2019) suggested there exist two color patterns of Lugol’s Chromendoscopy: yellow and brown-dark. The latter color is usually considered a normal mucous membrane in the past(Ishihara, Kanzaki et al 2013).…”

“…Why does exist such a difference in Lugol’s Iodine staining patterns in BLSCC? difficult diagnosis(Zhuang, Chen et al 2019) may lead to statistical models based on data from endoscopic technique and pathology, even next-generation sequencing, do not fully answer the first problem; further, the quantification of data’s randomness(Agresti and Franklin 2018) is not enough to explain the second problem and the mechanism hidden behind. Understanding the mechanism hidden behind it can help develop more effective diagnostic and therapeutic strategies; thus, our problems need to be explained differently: a mechanistic model based on the histological structure.…”