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Kmeid M, Lee G, Yang Z, Pacheco R, Lin J, Patil DT, Youssef M, Zhang Q, Alkashash AM, Li J, Lee H. Clinical Significance and Prognostic Implications of Discontinuous Growth Pattern in Esophageal Adenocarcinoma: A Multi-Institutional Study. Am J Surg Pathol 2024; 48:447-457. [PMID: 38238961 DOI: 10.1097/pas.0000000000002182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
The significance of discontinuous growth (DG) of the tumor to include tumor deposits and intramural metastasis in esophageal adenocarcinoma (EAC) is unclear. Esophagectomy specimens from 151 treatment-naïve and 121 treated patients with EAC were reviewed. DG was defined as discrete (≥2 mm away) tumor foci identified at the periphery of the main tumor in the submucosa, muscularis propria, and/or periadventitial tissue. Patients' demographics, clinicopathologic parameters, and oncologic outcomes were compared between tumors with DG versus without DG. DGs were identified in 16% of treatment-naïve and 29% of treated cases ( P =0.01). Age, gender, and tumor location were comparable in DG+ and DG- groups. For the treatment-naïve group, DG+ tumors were larger with higher tumor grade and stage and more frequent extranodal extension, lymphovascular/perineural invasion, and positive margin. Patients with treated tumors presented at higher disease stages with higher rates of recurrence and metastasis compared with treatment-naïve patients. In this group, DG was also associated with TNM stage and more frequent lymphovascular/perineural spread and positive margin, but not with tumor size, grade, or extranodal extension. In multivariate analysis, in all patients adjusted for tumor size, lymphovascular involvement, margin, T and N stage, metastasis, neoadjuvant therapy status, treatment year, and DG, DG was found to be an independent adverse predictor of survival outcomes in EAC. DG in EAC is associated with adverse clinicopathologic features and worse patient outcomes. DG should be considered throughout the entire clinicopathologic evaluation of treatment-naïve and treated tumors as well as in future staging systems.
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Affiliation(s)
- Michel Kmeid
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY
| | - Goo Lee
- Department of Pathology, University of Alabama at Birmingham, AL
| | - Zhaohai Yang
- Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Richard Pacheco
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY
| | - Jingmei Lin
- Pathology, Indiana University, Indianapolis, IN
| | - Deepa T Patil
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Mariam Youssef
- Department of Pathology, University of Alabama at Birmingham, AL
| | - Qingzhao Zhang
- Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Jingwei Li
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Hwajeong Lee
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY
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Yang MQ, Sun MJ, Zhang HJ. Mucosal esophageal carcinoma following endoscopic submucosal dissection with giant gastric metastasis: A case report and review of literature. World J Gastroenterol 2023; 29:5935-5944. [PMID: 38111508 PMCID: PMC10725560 DOI: 10.3748/wjg.v29.i44.5935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/15/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Esophageal carcinoma is a highly aggressive digestive cancer responsible for a notable proportion of cancer-related deaths worldwide. Its elevated metastatic rate contributes to a poor prognosis in affected patients. In this case review, we aim to summarize the metastatic characteristics of intramural gastric metastasis (IGM) in mucosal esophageal squamous carcinoma. CASE SUMMARY A 56-year-old man was admitted to our hospital because of a dry cough with an esophageal sensation for one year. Endoscopic examination revealed a 2.0 cm 1.0 cm, superficial esophageal squamous cell carcinoma, and the patient underwent endoscopic submucosal dissection (ESD). Fifteen months after ESD, positron emission tomography/computed tomography revealed that the metabolism of the stomach cardia wall had increased slightly. However, the mucosa of the gastric cardia was smooth under gastroendoscopy. Two years after ESD, endoscopic examination revealed a giant gastric cardia carcinoma, while the esophageal mucosa was smooth, and no advanced cancer was found. A biopsy of the gastric cardia indicated squamous-cell carcinoma. The patient received immunochemotherapy and radiotherapy for esophageal cancer for 8 mo and is currently under follow-up. CONCLUSION Early-stage esophageal carcinoma with IGM is rare. Despite the ESD of the primary lesion, IGM may still occur and should be closely monitored after ESD.
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Affiliation(s)
- Mei-Qi Yang
- Department of Gastroenterology, The First Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Ming-Jun Sun
- Department of Endoscopy, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Hui-Jing Zhang
- Department of Gastroenterology, The First Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
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Abstract
In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.
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Affiliation(s)
- Simone Giacopuzzi
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Maria Bencivenga
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Jacopo Weindelmayer
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Giovanni de Manzoni
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy.
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Namikawa T, Kobayashi M, Hanazaki K. Esophageal tumor after radical surgery for gastric cancer. Gastroenterology 2015; 148:e9-10. [PMID: 25726741 DOI: 10.1053/j.gastro.2014.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/15/2014] [Accepted: 10/31/2014] [Indexed: 02/08/2023]
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Hashimoto T, Arai K, Yamashita Y, Iwasaki Y, Hishima T. Characteristics of intramural metastasis in gastric cancer. Gastric Cancer 2013; 16:537-42. [PMID: 23314831 DOI: 10.1007/s10120-012-0228-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 12/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intramural metastasis (IM) in gastric cancer is rare. However, it often occurs with esophageal squamous cell carcinoma and has been reported to have a poor prognosis. METHODS In 4,714 cases of gastric cancer that underwent gastrectomy, the clinicopathological features and postoperative prognoses of 29 cases with IM were evaluated and compared with 2,770 cases of advanced gastric cancer without IM. RESULTS Of the 4,714 cases, 29 (0.6 %) were histopathologically diagnosed with gastric cancer with IM. There were significant differences in the number of lymph node metastases, capillary invasion, and stage grouping between cases with IM and advanced gastric cancer without IM. Metastasis size was approximately within 2 cm, and many metastases occurred within 2 cm of the primary lesion. Multiple metastases were observed in 38 % of cases and occurred mainly in the submucosa and muscularis propria. IM was detected preoperatively in 17.2 % of cases and was present equally on both sides of the primary lesion. Nine cases had IM outside the stomach. The median survival time with IM was significantly less than in cases of advanced gastric cancer without IM (p < 0.0001). A subgroup of cases with IM within 1 cm of the primary lesion had a relatively favorable prognosis. CONCLUSIONS The presence of IM is thought to be one of the most important prognostic factors in gastric cancer. Aggressive resection is recommended to increase long-term survival if curative resection is possible.
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Affiliation(s)
- Tatsuya Hashimoto
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan,
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Ki SH, Jeong S, Park IS, Lee DH, Lee JI, Kwon KS, Kim HG, Shin YW. Esophageal mucosal metastasis from adenocarcinoma of the distal stomach. World J Gastroenterol 2013; 19:3699-3702. [PMID: 23801875 PMCID: PMC3691037 DOI: 10.3748/wjg.v19.i23.3699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/12/2013] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
Dissemination of gastric cancer may usually occur by direct spread through the perigastric tissues to adjacent organ, lymphatic spread, and hematogenous spread. We report a rare case of gastric cancer with mucosal metastastic lesion on the upper esophagus that was diagnosed by endoscopy and endosonography. A biopsy of the esophageal mass was performed and the pathologic findings with immunohistochemical stain for Mucin-5AC are proved to be identical to that of gastric adenocarcinoma, suggesting metastasis from main lesion of the gastric cancer. The lesion could not be explained by lymphatic or hematogenous spread, and its metastasis mechanism is considered to be different from previous studies. We suggest that the gastroesophageal reflux of cancer cells could be one of the possible metastatic pathways for metastasis of esophagus from an adenocarcinoma of the stomach.
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Ito T, Sato K, Maekawa H, Sakurada M, Orita H, Kushida T, Komatsu Y, Wada R. A case of duodenal intramural metastasis from gastric cancer. Int J Surg Case Rep 2013; 4:500-3. [PMID: 23562902 DOI: 10.1016/j.ijscr.2013.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/27/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Here, we report a case of duodenal intramural metastasis from gastric cancer, which is extremely rare. PRESENTATION OF CASE A 72-year-old man was admitted to our hospital with a chief complaint of lack of appetite in 2010. An endoscopic evaluation detected a Borrmann type 2 tumor occupying the lesser curvature of the gastric body and antrum, and pyloric stenosis. The patient underwent total gastrectomy. In an examination of the resected specimen, a type 2 tumor was identified in the middle gastric body and antrum, and a submucosal tumor was detected in the duodenal bulb. A histopathological examination demonstrated that the gastric tumor was not contiguous with the duodenal submucosal tumor. A microscopic examination demonstrated that the gastric tumor was a moderately to poorly differentiated adenocarcinoma and displayed lymphatic permeation. The duodenal submucosal tumor was also found to be an adenocarcinoma and was similar to the gastric tumor; therefore, we diagnosed the duodenal tumor as an intramural metastasis from gastric cancer. DISCUSSION The most common route of metastasis from gastric cancer involves hematogenous metastasis, lymph node metastasis, and peritoneal metastasis. Intramural metastasis from gastric cancer is rare and has been reported to be a variant of lymphogenic metastasis. The clinicopathological features of patients with duodenal intramural metastasis from gastric cancer are unclear because only one case of the condition has been reported. CONCLUSION Duodenal intramural metastasis from gastric cancer is an advanced form of cancer, and we suggest that it should be treated with surgical resection followed by adjuvant therapy.
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Yoshida H, Tanaka N, Suzuki Y. Primary Adenocarcinoma of the Jejunum with Intramural Metastasis: Is This a Rare Event? J Gastrointest Cancer 2012; 43 Suppl 1:S276-9. [PMID: 22752454 DOI: 10.1007/s12029-012-9411-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroshi Yoshida
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan.
| | - Noriyuki Tanaka
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan
| | - Yoshio Suzuki
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan
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Ikeda O, Toh Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Sakaguchi Y, Okamura T, Hirahashi M, Nishiyama K, Baba H. Multiple and metachronous esophageal intramural metastases from a gastric adenocarcinoma. Gastric Cancer 2008; 11:119-22. [PMID: 18595019 DOI: 10.1007/s10120-007-0449-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 12/16/2007] [Indexed: 02/07/2023]
Abstract
Esophageal squamous cell carcinoma is often accompanied by intramural metastases, and it has been reported to carry a poor prognosis. Intramural metastasis from gastric cancer to the esophageal wall, however, has rarely been reported. We herein report a rare case of a 46-year-old man with an elevated esophageal lesion, resembling a 0-IIa-type esophageal cancer, which was discovered 13 months after a total gastrectomy performed for gastric cancer. The esophageal tumor, resected by endoscopic mucosal resection (EMR), was an adenocarcinoma with the same histology as the previously resected primary gastric cancer, and it showed massive lymphatic permeation. Soon after the EMR, other similar lesions emerged on the esophageal wall. We therefore considered the esophageal tumor to be a systemic expansion of the primary gastric cancer, and we administered the anticancer drug, S-1. Esophageal intramural metastases from a gastric cancer imply a systemic expansion of the gastric cancer, and portend a poor prognosis.
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