Immunohistochemical detection of carcinoembryonic antigen in esophageal carcinomas: a comparison with other gastrointestinal neoplasms.

Although the prognostic value of Carcinoembryonic antigen (CEA) in colorectal cancer follow-up is well known, CEA expression in esophageal cancer is not widely recognized and studies correlating tissue CEA expression in stomach cancers with tumor differentiation have yielded contradictory results. We compared the CEA expression in esophageal, gastric and colorectal carcinomas in order to elucidate its diagnostic and prognostic significance and to evaluate the potential role of tissue CEA localization for the clinical evaluation of esophageal carcinomas. CEA expression in 84 biopsies of carcinomas of the gastrointestinal tract (38 colorectal, 22 gastric, 24 esophageal) was evaluated by immunohistochemistry. Sixty-two percent of the squamous carcinomas of esophagus, all five esophageal adenocarcinomas arising in Barrett esophagus, 86 percent of gastric adenocarcinomas and 89 percent of colorectal adenocarcinomas were CEA-positive. In colorectal and gastric adenocarcinomas, CEA staining was present, usually at the luminal membrane of neoplastic glands and in intraluminal material. Signet ring cells were strongly positive for CEA. In esophageal carcinomas staining was mostly cytoplasmic and in the better differentiated tumors it was particularly prominent at the center of epithelial pearls. Intensity of staining was highest in well-differentiated carcinomas and lowest in poorly-differentiated carcinomas. A clear correlation was seen between the degree of tumor differentiation and CEA expression for carcinomas of the esophagus, stomach and colon. Our results support the potential usefulness of CEA for monitoring the recurrence of gastric or esophageal tumors. Immunohistochemical determination of tumor CEA content could be a useful adjunct for the management of gastrointestinal carcinomas, by improving interpretation of serum CEA levels.