Adenocarcinoma of gastro-esophageal junction - Case report.

Adenocarcinoma of the gastro-esophageal junction (GEJ) remains a significant clinical problem that is increasing in incidence and is associated with a poor prognosis. The majority of patients present with advanced disease and less than 50% undergo curative treatment. To diagnose GE junction mass with conventional procedure like Barium swallow where endoscopy cannot be performed, CECT is done to access the potential spread of disease.

Transoral migration of peritoneal end of ventriculoperitoneal shunt with perforation of gastro-esophageal junction: a case report of a rare complication.

A rare complication of ventriculoperitoneal (VP) shunt is presented. A 11-year old boy presented with a tube coming out of the mouth. He had multiple VP shunt done earlier. Clinical features, laboratory investigations and imaging studies showed that the peritoneal end had perforated the gastro-oesophageal junction and then prolapsed trans-orally. The shunt was removed and he made an uneventful recovery. Though migration of the peritoneal end of the shunt tube into various organs is known, to our knowledge, only six/seven cases have been reported in the English literature of a shunt tube coming out of the mouth and this is the next. The management of this very rare problem is discussed.

Carcinoma escamoso sarcomatoide de la unión gastroesofágica: caso clínico / Esophageal sarcomatoid squamous carcinoma: Report of one case

Sarcomatoid squamous carcinoma (ESC) is a rare esophageal neoplasm, with a clinical, etiological and pathological behavior that differs from squamous cancer. From the histological point of view it has a dual configuration. The squamous epithelial component is usually limited to small areas, while the major part is constituted by mesenchymatous (sarcomatoid) polypoid tissue. Treatment is esophagectomy or total esophagogastrectomy depending on the tumor location. Early detection is critical in terms of survival. For large lesions, preoperative chemo-radiotherapy can be considered. We report a 78-year-old male presenting with dysphagia. An upper gastrointestinal endoscopy showed a tumor located below the cardia. The patient was subjected to a total esophageal and gastric resection. In a second operation, the digestive transit was reconstituted in 2 steps. The pathology report informed a sarcomatoid squamous carcinoma. After 18 months of follow up, the patient is ambulatory.

The Clinicopathological Characteristics of Adenocarcinoma of the Gastro-esophageal Junction

PURPOSE: Siewert's classification of adenocarcinoma of the esophagogastric junction (AEG) has been widely adopted, but there is a wide discrepancy of the clinicopathological features of AEG of the Asian patients as compared to that of the Western patients. The aim of this study was to investigate the clinicopathological characteristics of AEG according to the Siewert classification. MATERIALS AND METHODS: Among the patients who underwent surgery for gastric carcinoma in our institution between May 2004 and February 2008, the AEG patients were selected based on their operation records and the photographs according to Siewert's classification. RESULTS: There were 70 AEG patients (3.9%) among the total of 1,778 patients. There were 3 patients (4.3%) with type I, 30 patients (42.8%) with type II and 37 patients (52.8%) with type III. Curative resection (R0) was achieved in 68 cases (97.1%). No significant differences in gender, stage, Barrett's esophagus and the proximal margin were found between the patients with type II and type III AEG. The patients with type III were younger than the patients with type II (59 vs 64 years, respectively, P=0.049). Well differentiated histology (P=0.045) and the intestinal type (P=0.055) were significantly more frequent in the patients with type II as compared with that in the patients with type III. CONCLUSION: There was a striking difference of the Asian patients from the Western patients for the incidence of AEG (and especially type I). Some of the differences between type II and type III patients were similar to those of the previous Western studies. A large study is needed to investigate whether these features are typical in the Korean population.

Adenocarcinoma of the Gastro-esophageal Junction: Application of Siewert's Classification to the Eastern Experience

PURPOSE: Since the approval of Siewert's classification during the 2nd International Gastric Cancer Congress in 1997, there has been no report on gastro-esophageal junction (GEJ) cancer using this new classification in Korea. The aim of this study was to assess the clinical usefulness of the new classification by applying it to the Eastern experience. MATERIALS AND METHODS: One hundred forty-six patients with an adenocarcinoma of the GEJ who underwent surgery from January 1990 to December 1998 were retrospectively classified according to the Siewert's classification. RESULTS: There were 2 patients (1.4%) with type I, 37 patients (25.3%) with type II, and 107 patients (73.3%) with type III. The proportion of the GEJ cancer among all gastric cancer patients who underwent operation was found to be 6.6%. The average age was 46 years in type I, 53 years in type II, and 55 years in type III. All types of GEJ cancers predominantly affected men. No significant differences in the pathologic variables including gross appearance, tumor size, and histologic findings were found between type II and type III. A curative resection (R0) was achieved in 118 cases (80.8%) without difference among tumor types. Type I tumors were treated with a gastrectomy with distal esophagectomy. Most of the type II tumors were treated with a total gastrectomy, and in some patients, a transhiatal partial esophagectomy was added. Type III tumors were treated with a total gastrectomy. Among resected cases with curative intent, microscopic tumor involvement of the proximal resection margin was noted in two patients (6.3%) with type II tumors. Lymph node metastasis was found in 2 patients (100%) with type I, 24 patients (64.9%) with type II, and 66 patients (61.7%) with type III. Lymph nodes along the lesser curvature were the most common site of metastasis, followed by pericardial nodes. The main lymphatic drainage directed the lymph nodes along the left gastric artery among the group 2 nodes. There was no difference in patterns of lymph node metastasis between type II and type III. Postoperative complications occurred in 29 patients, and operative mortality was 2.7%. Five-year survival rates were 0% for type I, 54.3% for type II, and 51.8% for type III. CONCLUSION: The distribution of subtypes of adenocarcinomas of GEJ was markedly different in this study compared with reported Western data. Therefore, Siewert's classification is useful for discussing GEJ cancer in an international setting as it clearly specifies the subtype of GEJ cancer. However, discrimination of type II and type III may have little clinical benefit since there were no significant differences in clinicopathologic characteristics or in the recommended types of surgery.