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 21 May 2018

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News

Reclassification differentiates esophageal cancer from GERD

A proposed redefinition of the gastroesophageal junction shows that most patients would be classified as adenocarcinoma of the distal esophagus, reports April's American Journal of Surgical Pathology.

News image

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Adenocarcinoma of the distal esophagus and gastric cardia are defined by the relationship of its epicenter to the gastroesophageal junction.

The gastroesophageal junction is presently defined as the end of the tubular esophagus.

It has recently been suggested that the true gastroesophageal junction is best defined by the proximal limit of gastric oxyntic mucosa.

Dr Tom DeMeester and colleagues reclassified adenocarcinomas of this region by the relationship of the tumor to the proximal limit of gastric oxyntic mucosa.

71 of 74 patients would be classified as adenocarcinoma of the distal esophagus
American Journal of Surgical Patholog

The team evaluated 74 patients who had esophagogastrectomy for adenocarcinomas in this region.

The team classified adenocarcinoma of distal esophagus in 38 patients.

The research team classified gastric cardia in 36 patients by present criteria.

The epithelial type at the epicenter and distal edge of these tumors was assessed.

The researchers found the epicenter of the tumor in 64 patients with noncircumferential tumors.

Of these patients, 5 had squamous, 21 had cardiac, 4 had oxynto-cardiac, and 34 had intestinal Barrett-type epithelia.

The team observed no gastric oxyntic mucosa in any of the patients.

Of the 10 patients with circumferential tumors, 7 had cardiac or oxynto-cardiac epithelium at the distal tumor edge.

Dr DeMeester's team concluded, “If the gastroesophageal junction is defined histologically as the proximal limit of oxyntic mucosa, most patients would be classified as adenocarcinoma of the distal esophagus.”

“The remaining 3 patients not classified were questionable as to gastric or esophageal origin.”

“We suggest that this reclassification provides an explanation for the epidemiologic relationship that exists between adenocarcinoma of the ‘gastric cardia' and gastroesophageal reflux disease.”

Am J Surg Path 2007: 31(4):569-75
02 April 2007

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