Gastroesophageal tube of the Iguana iguana (Iguanidae): histological description, histochemical and immunohistochemical analysis of 5-HT and SS cells / Tubo gastroesofágico da Iguana iguana (Iguanidae): descrição histológica, histoquímica e análise imunohistoquímica de células 5-HT e SS

Abstract The work aims were to describe the histological and histochemical structure of the gastroesophageal tube of Iguana iguana and verify the occurrence and distribution of immunoreactive serotonin (5-HT) and somatostatin (SS) cells. Fragments of the gastrointestinal tract (GIT) of five iguanas were which underwent standard histological and immunohistochemistry technique. Immunoreactive cells for 5-HT and SS were quantified using the STEPanizer. The oesophagus has ciliated columnar pseudostratified epithelium with staining Alcian blue (AB) + and goblet cells highly reactive to periodic acid Schiff (PAS). In the cervical oesophagus, the numerical density of 5-HT cells per unit area (QA [5-HT cells]/µm2) was 4.6x10-2 ± 2.0 and celomatic oesophagus presented QA = 4.0x10-2 ± 1.0. The epithelium of the stomach is simple columnar, PAS and AB +. The cranial and middle regions of the stomach presented (QA [5-HT cells]/µm2) = 6.18x10-2 ± 3.2 and the caudal region, QA = 0.6x10-2 ± 0.2. The SS cells were only observed in the caudal stomach, with numerical density (QA [SS cells]/µm2) = 1.4x10-2 ± 0.9 In I. iguana, variation was observed in terms of the distribution of mucus secretions and the pattern of occurrence of serotonin and somatostatin-secreting enteroendocrine cells in the TGI, which possibly will result in an interspecific adaptive response.

Resumo Os objetivos do trabalho foram descrever a estrutura histológica e histoquímica do tubo gastroesofágico da Iguana iguana e verificar a ocorrência e distribuição de células serotonina (5-HT) e somatostatina (SS) imunorreativas. Fragmentos do trato gastrointestinal (TGI) de cinco iguanas foram submetidos à técnica histológica e imunohistoquímica padrão. As células imunorreativas para 5-HT e SS foram quantificadas usando o STEPanizer. O esôfago apresenta epitélio pseudoestratificado colunar ciliado Alcian blue (AB) positivo, com células caliciformes altamente reativas ao ácido periódico de Schiff (PAS). No esôfago cervical, a densidade numérica de células 5-HT por unidade de área (QA [células 5-HT] / µm2) foi de 4.6x10-2 ± 2.0 e o esôfago celomático apresentou QA = 4.0x10-2 ± 1.0. O epitélio do estômago é colunar simples, PAS e AB positivo. As regiões cranial e média do estômago apresentaram (QA [células 5-HT] / µm2) = 6.18x10-2 ± 3.2 e a região caudal, QA = 0.6x10-2 ± 0.2. As células SS foram observadas apenas no estômago caudal, com densidade numérica (QA [células SS] / µm2) = 1.4x10-2 ± 0.9. Em I. iguana, foi observada variações em termos da distribuição das secreções de muco e padrão de ocorrência das células enteroendócrinas secretoras de serotonina e somatostatina no TGI, o que possivelmente reflete uma resposta adaptativa interespecifica.

Gastroesophageal tube of the Iguana iguana (Iguanidae): histological description, histochemical and immunohistochemical analysis of 5-HT and SS cells / Tubo gastroesofágico da Iguana iguana (Iguanidae): descrição histológica, histoquímica e análise imunohistoquímica de células 5-HT e SS

The work aims were to describe the histological and histochemical structure of the gastroesophageal tube of Iguana iguana and verify the occurrence and distribution of immunoreactive serotonin (5-HT) and somatostatin (SS) cells. Fragments of the gastrointestinal tract (GIT) of five iguanas were which underwent standard histological and immunohistochemistry technique. Immunoreactive cells for 5-HT and SS were quantified using the STEPanizer. The oesophagus has ciliated columnar pseudostratified epithelium with staining Alcian blue (AB) + and goblet cells highly reactive to periodic acid Schiff (PAS). In the cervical oesophagus, the numerical density of 5-HT cells per unit area (QA [5-HT cells]/µm2) was 4.6x10-2 ± 2.0 and celomatic oesophagus presented QA = 4.0x10-2 ± 1.0. The epithelium of the stomach is simple columnar, PAS and AB +. The cranial and middle regions of the stomach presented (QA [5-HT cells]/µm2) = 6.18x10-2 ± 3.2 and the caudal region, QA = 0.6x10-2 ± 0.2. The SS cells were only observed in the caudal stomach, with numerical density (QA [SS cells]/µm2) = 1.4x10-2 ± 0.9 In I. iguana, variation was observed in terms of the distribution of mucus secretions and the pattern of occurrence of serotonin and somatostatin-secreting enteroendocrine cells in the TGI, which possibly will result in an interspecific adaptive response.

Os objetivos do trabalho foram descrever a estrutura histológica e histoquímica do tubo gastroesofágico da Iguana iguana e verificar a ocorrência e distribuição de células serotonina (5-HT) e somatostatina (SS) imunorreativas. Fragmentos do trato gastrointestinal (TGI) de cinco iguanas foram submetidos à técnica histológica e imunohistoquímica padrão. As células imunorreativas para 5-HT e SS foram quantificadas usando o STEPanizer. O esôfago apresenta epitélio pseudoestratificado colunar ciliado Alcian blue (AB) positivo, com células caliciformes altamente reativas ao ácido periódico de Schiff (PAS). No esôfago cervical, a densidade numérica de células 5-HT por unidade de área (QA [células 5-HT] / µm2) foi de 4.6x10-2 ± 2.0 e o esôfago celomático apresentou QA = 4.0x10-2 ± 1.0. O epitélio do estômago é colunar simples, PAS e AB positivo. As regiões cranial e média do estômago apresentaram (QA [células 5-HT] / µm2) = 6.18x10-2 ± 3.2 e a região caudal, QA = 0.6x10-2 ± 0.2. As células SS foram observadas apenas no estômago caudal, com densidade numérica (QA [células SS] / µm2) = 1.4x10-2 ± 0.9. Em I. iguana, foi observada variações em termos da distribuição das secreções de muco e padrão de ocorrência das células enteroendócrinas secretoras de serotonina e somatostatina no TGI, o que possivelmente reflete uma resposta adaptativa interespecifica.

Gastroesophageal tube of the Iguana iguana (Iguanidae): histological description, histochemical and immunohistochemical analysis of 5-HT and SS cells

Abstract The work aims were to describe the histological and histochemical structure of the gastroesophageal tube of Iguana iguana and verify the occurrence and distribution of immunoreactive serotonin (5-HT) and somatostatin (SS) cells. Fragments of the gastrointestinal tract (GIT) of five iguanas were which underwent standard histological and immunohistochemistry technique. Immunoreactive cells for 5-HT and SS were quantified using the STEPanizer. The oesophagus has ciliated columnar pseudostratified epithelium with staining Alcian blue (AB) + and goblet cells highly reactive to periodic acid Schiff (PAS). In the cervical oesophagus, the numerical density of 5-HT cells per unit area (QA [5-HT cells]/µm2) was 4.6x10-2 ± 2.0 and celomatic oesophagus presented QA = 4.0x10-2 ± 1.0. The epithelium of the stomach is simple columnar, PAS and AB +. The cranial and middle regions of the stomach presented (QA [5-HT cells]/µm2) = 6.18x10-2 ± 3.2 and the caudal region, QA = 0.6x10-2 ± 0.2. The SS cells were only observed in the caudal stomach, with numerical density (QA [SS cells]/µm2) = 1.4x10-2 ± 0.9 In I. iguana, variation was observed in terms of the distribution of mucus secretions and the pattern of occurrence of serotonin and somatostatin-secreting enteroendocrine cells in the TGI, which possibly will result in an interspecific adaptive response.

Resumo Os objetivos do trabalho foram descrever a estrutura histológica e histoquímica do tubo gastroesofágico da Iguana iguana e verificar a ocorrência e distribuição de células serotonina (5-HT) e somatostatina (SS) imunorreativas. Fragmentos do trato gastrointestinal (TGI) de cinco iguanas foram submetidos à técnica histológica e imunohistoquímica padrão. As células imunorreativas para 5-HT e SS foram quantificadas usando o STEPanizer. O esôfago apresenta epitélio pseudoestratificado colunar ciliado Alcian blue (AB) positivo, com células caliciformes altamente reativas ao ácido periódico de Schiff (PAS). No esôfago cervical, a densidade numérica de células 5-HT por unidade de área (QA [células 5-HT] / µm2) foi de 4.6x10-2 ± 2.0 e o esôfago celomático apresentou QA = 4.0x10-2 ± 1.0. O epitélio do estômago é colunar simples, PAS e AB positivo. As regiões cranial e média do estômago apresentaram (QA [células 5-HT] / µm2) = 6.18x10-2 ± 3.2 e a região caudal, QA = 0.6x10-2 ± 0.2. As células SS foram observadas apenas no estômago caudal, com densidade numérica (QA [células SS] / µm2) = 1.4x10-2 ± 0.9. Em I. iguana, foi observada variações em termos da distribuição das secreções de muco e padrão de ocorrência das células enteroendócrinas secretoras de serotonina e somatostatina no TGI, o que possivelmente reflete uma resposta adaptativa interespecifica.

MINIMAL ACCESS SURGERY IN CARCINOMA OESOPHAGUS - A CASE REPORT

Surgery plays an important role in curative treatment of oesophageal carcinoma. Ivor-Lewis procedure modified by McKeown is the procedure of choice, which is an open approach. Here, we present our experience with a modified three-stage procedure i.e. right thoracoscopy, mini-laparotomy and cervical anastomosis, which shows that oncological procedures can be performed by minimally invasive procedures; this helps in reducing complications associated with open technique, especially pulmonary, without any oncological disadvantage for the patient. Thus, we propose that a minimally invasive approach is a significantly better technique for tumour resection, combined with neo adjuvant chemotherapy, in reducing hospital stay and improved quality of life.

Coincidencia de hallazgos endoscópicos e histológicos en el diagnóstico de esófago de Barrett / Coincidence of endoscopic and histological findings in the diagnosis of Barrett's esophagus

Introducción: el esófago de Barrett es una alteración en la cual la mucosa esofágica se transforma desde un epitelio escamoso a un epitelio columnar con metaplasia intestinal. Endoscópicamente esta lesión se corresponde con la presencia de una mucosa columnar de color rojo salmón por encima de la unión gatroesofágica. Para su diagnóstico se requiere de la sospecha endoscópica y la confirmación histológica. Objetivo: determinar los niveles de coincidencia entre los diagnósticos endoscópicos y las características histopatológicas del esófago de Barrett, a partir del análisis de una serie de casos. Métodos: se realizó un estudio retrospectivo, en el Hospital Clínico Quirúrgico "Joaquín Albarrán" de La Habana, Cuba entre enero de 2017 a junio de 2019, obteniéndose los datos de los registros de biopsias e historias clínicas. Se realizaron cálculos de frecuencias absolutas y relativas y, para evaluar la fuerza de coincidencia entre endoscopia e histología, se utilizó el estadístico Chi cuadrado. Resultados: en los 67 casos con diagnóstico endoscópico la coincidencia con histopatológica fue del 44,8%, en el restante 55,2% de los pacientes las lesiones diagnosticadas fue esofagitis crónica (p = 0,005). Conclusiones: el esófago de Barrett es una de las entidades clínicas con una epidemiología de alta variabilidad y su diagnóstico endos-cópicos requiere de la confirmación histológica ya que existe una baja coincidencia entre el diagnóstico endoscópico e histopatológico del EB el cual es el estándar de oro para el diagnóstico de EB.

Background: Barrett's oesophagus is an alteration in which the oesophagal mucosa is transformed from squamous epithelium to co-lumnar epithelium with intestinal metaplasia. Endoscopically this lesion corresponds to the presence of a salmon-red columnar mucosa above the gastroesophageal junction. For its diagnosis, endoscopic suspicion and histological confirmation are required.Objective: To determine the levels of coincidence between the endoscopic diagnoses and the histopathological characteristics of Barrett's oesophagus, from the analysis of a series of cases. Methods: A retrospective study was carried out at the "Joaquín Albarrán" Surgical Cli-nical Hospital in Havana, Cuba, between January 2017 and June 2019, obtaining data from biopsy records and medical records. Absolute and relative frequency calculations were performed and, to evaluate the force of coincidence between endoscopy and histology, the Chi-square statistic was used. Results: In the 67 cases with endoscopic diagnosis, the coincidence with histopathology was 44.8%, in the remaining 55.2% of the patients the lesions diagnosed were chronic esophagitis (p = 0.005). Conclusions: Barrett's oesophagus is one of the clinical entities with the epidemiology of high variability, and its endoscopic diagnosis requires histological confirmation since there is a low coincidence between the endoscopic and histopathological diagnosis of EB which is the gold standard for EB diagnosis.

Swallowed dentures in thoracic oesophagus

Oesophagus is the second most (46.8%) common site of impaction of foreign body in the gastro-intestinal tract. Dentures constitute the 3rd most common (2.4%) foreign body in oesophagus of adults, following meat bone (76.1%) and coin (3.6%).In our Institute, impacted dentures in esophageal are referred to our department after a failed endoscopic venture at removal by ENT surgeons. Extraction in such a situation calls for judicial planning and careful timing of the procedure to achieve satisfactory results. The present study was done on 11 cases of thoracic oesophageal dentures which were removed surgically in the Department of CTVS Medical College and Hospital, Kolkata over 2 years of period. Between 1st October 2017 to 30st September 2019, 11 dentures were extracted from thoracic oesophagus via right postero-lateral thoracotomy approach. The defect in the oesophagus after denture removal was primarily closed; with reinforcement using intercostals muscle pedicled flap. A defunctioning cervical oesophagostomy and a feeding jejunostomy (FJ) were done in all cases. Surgical leaks were noted in 5 cases, of which 1 lady had fulminant mediastinitis before she died. Pneumonia was observed in 4 cases, superficial surgical wound infection in 2 cases, blocked FJ tube in 1 case and leakage following closure of cervical oesophagostomy in 3 cases. Thoracic esophageal dentures are serious surgical entities which need early diagnosis and management. Pre-operative optimization is very important for avoiding surgical leakage.

Prospective study on radiation dose escalation in the treatment of squamous cell carcinoma of oesophagus with definitive concurrent chemo-radiation using three-dimensional conformal radiation therapy

Background: Poor local control and survival rates associated with radiation and chemotherapy in the management of locally advanced carcinoma of oesophagus have encouraged use of radiation dose escalation. This study analysed outcome and tolerance of radiation dose escalation with concurrent chemotherapy in non-metastatic squamous cell carcinoma of oesophagus. Materials and Methods: Patients diagnosed with stage I-III squamous cell carcinoma oesophagus, intended to be treated with radical chemo-radiation, between August 2015 to August 2017 were included in this prospective study. Baseline endoscopy, oral intake score and FACT E-QOL score were documented. Patients were treated with radiation dose of 60Gy in 2Gy per fraction schedule (initial 46Gy followed by 14Gy boost to tumour alone) with concurrent 3-weekly 5-FU/Cisplatin or weekly Cisplatin alone regimen. Results: Out of total of 20 eligible patients with median age of 64 years, majority had middle thoracic oesophageal tumour (60%), grade 2 dysphagia (75%) on oral intake scale. Patients with tumour length of ≤5cm (55%) or >5cm (45%) were categorised. Majority patients (85%) showed complete response at 3 months post treatment. The oral intake score and quality of life improved in 55% and 85%of the patients, respectively. Ten patients had disease progression with 40% of patients showing disease recurrence. No patient developed oesophageal fistula, radiation-pneumonitis or cardiac toxicity. Median disease-free survival and overall survival was 16 months (95% CI, 10-21 months) and 28 months (95% CI, 13-42 months) with 1-year and 2-year survival rates of 72.4% and 53.7%, respectively. Conclusion: Radiation dose escalation with concurrent chemotherapy in the management of stage I-III, non-metastatic squamous cell carcinoma oesophagus yields a good local control rate at 3 months with less severe complications and improved quality of life.

Basaloid Squamous Cell Carcinoma of Oesophagus: Definitely Rare but does it Differs Significantly from the Conventional Squamous Cell Carcinoma.

Introduction: Basaloid squamous cell carcinoma (BSCC)is a rare, poorly differentiated variant of squamous cellcarcinoma (SCC). The diagnosis is made only after exclusionof conventional squamous cell carcinoma, adenoid cysticcarcinoma and small cell carcinoma. Our aim is to presenttwo cases of BSCCs identified in oesophagus with detailedclinicopathological, histological and immunohistochemicalfindings for better understanding of this rare entity which haslimited literature available to avoid misdiagnosis.Case Report: A detailed study of clinical and pathologicparameters in two cases of BSCC reported in our departmentwho had underwent potentially curative surgical resectionafter a preliminary post biopsy diagnosis was made.Microscopically, both the cases showed a quite similarpicture; they were composed of relatively small tumour cells,arranged in solid lobules with abundant comedo- necrosis.However, there were some minor variations as one of themwas accompanied by large areas of typical conventional SCC,whereas the other one showed presence of bizarre cells. Onimmunohistochemical analysis, the tumour cells showedstrong positivity for pan-CK with a high Ki67 index of 80-85%.Conclusion: BSCC have a poorer prognosis than conventionaloesophageal squamous cell carcinoma, but no definitivespecific treatment protocol has been established till date.Still these cases were considered worthy of discussion due tothe distinctness of this entity especially considering the siteoesophagus where it is regarded to be quite rare, in addition toits aggressiveness and poor outcome.

Expression of Ki67 and CerbB-2 in Gall Bladder, Oesophageal, Small Intestinal and Colorectal Adenocarcinomas: A Study from a Tertiary Care Hospital in Western U.P.

Introduction: Gall bladder cancer is the commonestbiliary tract malignancy with poor prognosis. Oesophagealadenocarcinomas are aggressive with very poor survival.Adenocarcinomas of small intestine are rare, in comparisonto colorectal carcinomas. We studied the expression of twocommonly studied immunohistochemical markers Ki67 andCerbB-2 in gall bladder and gastrointestinal carcinomas, tofind out their prognostic significance.Material and Methods: Histopathologically confirmed casesof adenocarcinomas of gall bladder (19 cases), oesophagus(3 cases), small intestine (3 cases) and colorectal region (8cases) were included. Formalin fixed paraffin embeddedtissue blocks were retrieved and sections were studiedimmunohistochemically for expression of Ki67 and CerbB-2.Tumors of all stages and grades were studied.Results: Our study revealed a significantly high Ki67in neoplastic glands of gall bladder, oesophageal, smallintestinal and colorectal adenocarcinomas as comparedto the non neoplastic areas. The Ki67 labelling index washigher in moderately and poorly differentiated areas as wellas mucinous and signet ring type adenocarcinomas. Therewas no relation with stage/depth of tumor invasion. CerbB-2was significantly overexpressed in gall bladder and colorectaladenocarcinomas. Expression was higher in advanced stageand greater depth of invasion. There was no associationwith tumor grade or type. In esophageal and small intestineadenocarcinomas, expression was not related to either tumorstage or grade.Conclusion: A panel of Ki67 and CerbB-2 in gastrointestinaland biliary tract malignancies may correlate well with differentprognostic indicators in these malignancies, like tumor stage,histologic type and grade.

Relationship between type of smokeless tobacco & risk of cancer: A systematic review

Background & objectives: Causative linkages of smokeless tobacco (SLT) use with oral potentially malignant disorders and cancers of oral cavity, oesophagus and pancreas have been reported. Published meta-analyses have provided pooled risk estimates for major cancers caused by SLT, both on global and regional levels. This systematic review was aimed at summarizing the available studies on occurrence and mortality risk of common cancers due to various SLT products. Methods: PubMed and Google Scholar databases were systematically searched from 1985 till January 2018 for observational studies on SLT and cancer. The included studies were evaluated and data were extracted and reviewed. Results: The review included 80 studies providing 121 risk estimates for various cancers. Majority of the studies from South-East Asian Region (SEAR) and Eastern Mediterranean Region (EMR) showed a significant positive association of SLT use with oral [odds ratio (OR) ranging from 1.48 to 27.4] and oesophageal cancers (OR between 2.06 and 12.8), while studies from European Region (EUR) reported a positive association with pancreatic cancer (OR between 1.6 and 2.1). Cancer-related mortality was evaluated in a few reports with higher risk of mortality for lung (OR between 2.0 and 9.1), cervical (OR 2.0) and prostate (OR 2.1) cancers. A wide variation was noted in the association of various cancers and specific SLT products based on their nature, methods of use and inherent toxicity. The majority of chewing tobacco products displayed higher risk for oral and oesophageal cancers while the same was not observed for snus. Interpretation & conclusions: This review emphasizes on the significantly positive association of SLT use with oral and oesophageal cancers in SEAR and EMR and pancreatic cancer in EUR. Mortality estimates for SLT-associated cancers need further analysis. Risk analysis for cancers of other sites in SLT users also requires multicentric well-designed studies.

Carcinoma de esófago en un adolescente de 14 años de edad con esófago de Barrett: Reporte de un caso y revisión de la literatura / Oesophageal carcinoma in a14 year old with Barrett's oesophagus: Case report and literature review

Resumen Los carcinomas del esófago son neoplasias extremadamente raras en niños y adolescentes y la literatura médica está limitada a reportes y series de casos. En su etiología están asociados algunos factores de riesgo implicados con la inflamación y la irritación crónica de las paredes del esófago. Los autores presentan el caso de un adolescente de14 años de edad con retardo mental y esófago de Barrett que desarrolló un carcinoma adenoescamoso del tercio medio del esófago. Se describen las características clínicas, los hallazgos radiológicos, la patología y el tratamiento adyuvante y quirúrgico recibido por el paciente.

Abstract Carcinomas of the oesophagus are extremely rare neoplasms in children and adolescents, and the medical literature is limited to case reports and series. In its aetiology they are associated with some risk factors involved with inflammation and chronic irritation of the wall of the oesophagus. The authors present the case of a14 year old mentally retarded and Barrett's oesophagus that developed an adeno-squamous carcinoma of the middle third of the oesophagus. Clinical features, radiological findings, pathology and surgical and adjuvant treatment received by the patient are described.

The Use of the Prague Classification System in the Reporting of Barrett’s Surveillance Endoscopies.

Aims: The Prague classification for the reporting of Barrett’s oesophagus has been validated in previous studies and is recommended by the British Society of Gastroenterologists (BSG) in their latest guidelines. In this short study we aim to audit the adherence to the use of this system in endoscopy reports produced in a busy teaching hospital in the UK. Methods: We retrospectively audited all the reports for endoscopies performed as surveillance for patients with known Barrett’s oesophagus within a six month period. These reports were examined as to whether or not the Prague classification system was employed. Results: Sixty-seven reports were inspected and six were excluded as Barrett’s was not seen. Twenty-six of the 61 reports studied (43%) used the Prague classification system. The remainder used descriptions and length measurements felt appropriate by the endoscopist. Conclusions: The BSG guidelines emphasise the importance of measuring Barrett’s using a standard methodology. The rationale for this include aiding communication, increasing the level of diagnostic confidence and providing an estimate of the risk of adenocarcinoma development based on segment length. The use of the Prague classification is validated, explicit and consensus driven. However our study demonstrates that only 43% of endoscopy reports use the Prague system. The reason for this lack of adherence is unclear and may benefit from further study.

A comparative study of three-dimensional, four-dimensional, and cone beam contrast-enhanced computed tomography in measurement of the normal thickness of the esophageal wall / 中华放射肿瘤学杂志

Objective To compare the normal thickness of the esophageal wall measured by contrast?enhanced three?dimensional ( 3DCT ) , four?dimensional ( 4DCT ) , and cone beam computed tomography ( CBCT) ,and to provide a basis for target volume delineation in esophageal cancer. Methods From 2009 to 2016,thoracic contrast?enhanced 3DCT and 4DCT simulations were performed in 50 patients with lung cancer or metastatic lung cancer. Contrast?enhanced CBCT scans were acquired during the first three?dimensional conformal radiotherapy. The normal esophageal wall was contoured on 3DCT images, the end?exhalation phase of 4DCT images ( 4DCT50 ) , the maximum intensity projection of 4DCT images (4DCTMIP),and CBCT images. The wall thickness was measured on each segment and the average thickness of esophageal wall was obtained. Comparison of the thickness of a fixed segment of esophageal wall between different CT images was made by paired t test. Comparison of thickness on the same type of CT images between different segments of esophageal wall was made by one?way analysis of variance. Results For the thoracic and intra?abdominal segments,there was no significant difference in the thickness of esophageal wall between 3DCT and 4DCT50 images ( P= 0?056?0?550 );however, the thickness of esophageal wall was significantly smaller on 3DCT images than on 4DCTMIP or CBCT images (P=0?000?0?004).For the upper and middle thoracic segments,the thickness of esophageal wall was significantly larger on CBCT images than on 4DCTMIP images ( P= 0?008, P= 0?001 ) . On 3DCT, 4DCT50 , and 4DCTMIP images, the thickness of esophageal wall was significantly larger in the lower thoracic segment than in the upper or middle thoracic segments ( P=0.008~0?041);the intra?abdominal segment had a significantly larger thickness of esophageal wall than the thoracic segments ( all P=0?000 ) . There was no significant difference in wall thickness on CBCT images between three thoracic segments ( P=0.088~0?945) . Conclusions A uniform criterion can be adopted to judge the normal thickness of esophageal wall in gross tumor volume ( GTV ) delineation on 3DCT and 4DCT50 images for thoracic esophageal cancer. However,caution should be taken when 5 mm is used as a criterion for normal thickness of esophageal wall in GTV delineation on 4DCTMIP and CBCT images.

A case report on two superimposed foreign body coins in esophagus.

Foreign body ingestion is a common occurence. We report a case of 8 year old male who presented with history of foreign body ingestion (coin). He had frequent episodes of vomiting along with foreign body sensation. Later on two superimposed foreign body coins were removed by rigid oesophagoscopy.

Histological study of the oesophagus and stomach in grey-backed shrike (Lanius tephronotus) / Estudio histológico de esófago y estómago del alcaudón (Lanius tephronotus)

The microstructure of oesophagus and stomach in grey-backed shrike were examined by means of light microscopy. The results showed that the oesophagus glands were mucous glands, the shedding glandular cells and the mucin from the oesophagus glands secreted to the lumen. The number of the glands in the thoracic part was less than that of in the cervical part. The lumens of the glands showed an intense positive periodic acid-Schiff and Alcian blue reaction. There were two types of glands in the lamina propria. The simple tubular glands were located in the superficial lamella of the lamina propria, while compound tubular glands were located in the deep lamella. The epithelium was lined by a layer of cuticle in the intermediate zone between the proventriculus and gizzard. The surface of gizzard possessed a rough thick cuticle, which was made up of the Alcian blue-positive horizontal matrix and the periodic acid-Schiff-positive vertical rods.

La microestructura del esófago y el estómago del alcaudón gris fueron examinados mediante microscopía de luz. Los resultados mostraron que las glándulas del esófago eran glándulas mucosas, y que las células glandulares de descamación y la mucina de las glándulas del esófago eran secretadas al lumen. El número de glándulas en la porción torácica del esófago fue menor que en la porción cervical. Las aberturas de las glándulas mostraron una reacción positiva intensa al PAS y azul de Alcián. Se encontraron dos tipos de glándulas en la lámina propia. Las glándulas tubulares simples se localizaron en la lámina superficial de la lámina propia, mientras que las glándulas tubulares compuestas se hallaron en la lámina de profundidad. El epitelio se encontró revestido por una capa cuticular en la zona intermedia entre el proventrículo y la molleja. La superficie de la molleja presentó una cutícula gruesa, demostrada por una matriz horizontal positivo para azul de Alcian y varillas verticales positivas para el PAS.

Carcinosarcoma of oesophagus: A case report.

Oesophageal carcinosarcoma is a rare type of oesophageal cancer composed of both epithelial and mesenchymal components, occuring with an incidence of about 0.1-1.5 % of all oesophageal tumors. Most of the cases have been reported from Japan. Very few cases have been reported from India. We report a case of 65 year old female who presented with dysphagia and weight loss. Endoscopy revealed a bulky mass and the preliminary diagnosis was oesophageal carcinoma. On histology of the surgical specimen, the tumour revealed both epithelial and sarcomatous malignant cells. A tentative diagnosis of oesophageal carcinosarcoma was made. Immunohistochemical studies showed positivity for both pancytokeratin and vimentin thus confirming the diagnosis.

Neurogenous hyperplasia in the oesophagus

Leiomyoma and gastrointestinal stromal tumours take fi rst place among mesenchymal tumours of the oesophagus, where tumours of peripheral nerve origin are rarely seen. Schwann and enterochromaffi n cell proliferation occur in neurogenous hyperplasia, an entity observed in the appendix which has not been reported in the oesophagus in the medical literature. Oesophagogastroscopy of a 58-year-old woman showed linear erosions and nodularity at the gastroesophageal junction. The microscopic examination of biopsies taken from this area revealed proliferation of spindle cells with oval-round nuclei forming focal fascicular arrangement in the lamina propria. These cells stained positive for synaptophysin and S100-protein, while immunohistochemistry for smooth muscle actin and CD117 were negative. The case was diagnosed as neurogenous hyperplasia with these fi ndings. Control endoscopic biopsies showed no evidence of neurogenous hyperplasia. Neurogenous hyperplasia can be considered as a distinct entity which might also be observed in the oesophagus as in the appendix.

Status of confocal laser endomicroscopy in gastrointestinal disease.

Confocal laser endomicroscopy (CLE) is an advanced imaging technique which combines conventional white light endoscopy (WLE) with an integrated or probe based confocal microscope. This allows microscopic examination of the surface epithelium and in vivo diagnosis during endoscopy. Established CLE applications include the diagnosis of Barrett’s oesophagus, gastric intestinal metaplasia, coeliac disease and microscopic colitis. CLE can differentiate hyperplastic from adenomatous polyps in the colon and may obviate the need to biopsy all polyps at endoscopy. CLE is particularly helpful in surveillance endoscopy in inflammatory bowel disease where it has been shown to reduce the number of biopsies required and improve the detection of dysplasia. The future of CLE may be with new contrast agents to allow for molecular tagging and improved endoscopic diagnoses. The aim of this review is to describe the technology and techniques involved in CLE, and discuss the evolving applications in obtaining “virtual biopsy” throughout the GI tract.

Effect of Calabash Chalk on the Histomorphology of the Gastro-Oesophageal Tract of Growing Wistar Rats

Background: Calabash chalk is a naturally occurring mineral consumed by members of some Nigerian communities for pleasure and by pregnant women as a remedy for morning sickness. The consumption of this geophagic material motivated our interest on the effect of the chalk on the histomorphology of the gastro-oesophageal tract. Methods: Twenty-eight young Wistar rats, 4 weeks old, were divided into 4 groups of equal size. Group 1 animals served as controls and received 1 mL of distilled water. Groups 2, 3, and 4 received orally 1 mL of a Calabash chalk suspension containing 40 mg/mL for 14, 21, and 28 days, respectively. Upon completion of the treatments, the animals in groups 2, 3, and 4 were sacrificed on days 15, 22, and 29, respectively, and the control group animals were sacrificed on day 29. All animals were euthanised using chloroform anaesthesia. The oesophagus and the stomach of each animal were dissected out and routinely processed for histological studies. Results: There was oedema with haemorrhages in the mucosa of the stomach, and acanthosis, hyperkeratosis, and koilocytic changes were observed in the mucosa of the oesophagus of the groups treated with 40 mg/mL of Calabash chalk suspension. Conclusion: Calabash chalk caused histological changes to the stomach and the oesophagus that may lead to other pathophysiological conditions.

Tracheal injury during oesophagectomy – incidence, treatment and outcome.

Background and aim: Iatrogenic tracheal injuries are uncommon, potentially lethal and associated with significant morbidity. In this report we analyze the incidence of iatrogenic tracheobronchial injuries sustained during oesophagectomies and the results and outcome of repair using a pedicled intercostal muscle flap. Methods: A retrospective analysis was done on all patients who underwent an oesophagectomy between June 2000 and May 2011. Data was collected from an electronic database and the medical records of patients, maintained at our hospital. Results: One hundred and fourteen patient records were analyzed. There were 85 male and 29 female patients. Their mean age was 47 years (range 16 to 86 years). Forty two (36%) underwent a transhiatal oesophagectomy, 34(31%) Mckeown’s oesophagectomy, 35(31%) Ivor Lewis oesophagectomy and 3(2%) thoracoscopy assisted oesophagectomy. Of the 114 oesophagectomies, 86 (75%) were performed for malignant and 28 (25%) for benign pathologies (benign tumors and corrosive strictures of the esophagus). In our study, four patients sustained injury to the tracheobronchial tree during oesophagectomy. In patients who sustained injury during a transhiatal dissection a right anterolateral thoracotomy was made. All injuries in the thoracic tracheobronchial tree were repaired primarily and reinforced with an intercostal muscle flap. In the patient with injury to the cervical part of the trachea, repair was done primarily and reinforced with cyanoacrylate glue. All patients who sustained injury had malignancy and three patients had received neoadjuvant chemoradiotherapy. Two patients sustained injury during transhiatal oesophagectomy and two during a Mckeown’s oesophagectomy. There was one mortality which was due to ventilator associated pneumonia and related complications. The remaining three were alive with no evidence of repair breakdown. Conclusions: Iatrogenic tracheal injuries are uncommon complications but associated with significant morbidity. Preoperative chemoradiotherapy and malignancy are risk factors for iatrogenic tracheal injuries. Reinforcement of the suture line with a muscle flap is an effective technique of repair. Prompt ontable identification and adequate surgical treatment is necessary for a good outcome.