Aged ; Esophageal Neoplasms ; pathology ; Esophagogastric Junction ; Humans ; Male ; Melanoma ; pathology

Recently, the incidence of carcinoma at the esophagogastric junction (CEG), especially adenocarcinoma at esophagogastric junction (AEG) is increasing. AEG has obvious difference from other parts of stomach tumor in anatomy, physiology and pathology. The scholars have not made a consensus and standard about the treatment of AEG. It is necessary to improve the knowledge and cognition about AEG and find a feasible treatment strategy.
Adenocarcinoma ; pathology ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Esophagogastric Junction ; pathology ; Humans ; Stomach Neoplasms ; pathology ; surgery

Esophageal cancer (EC) has a high incidence and poor prognosis. The two major histological types, squamous cell carcinoma and adenocarcinoma, differ in their epidemiology and treatment options. Patients with locally advanced EC benefit from multimodal therapy concepts including neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy, and perioperative chemotherapy. Currently, immunotherapy for the solid tumor is a hot spot. Treatment with adjuvant immune checkpoint inhibitors (ICIs) is the first immunotherapy for resectable EC listed in the latest National Comprehensive Cancer Network Guidelines for the Esophageal and Esophagogastric Junction Cancers. Recent clinical trials have established ICIs for three treatment models of resectable EC. Their short-term results demonstrated ideal efficacy and tolerable toxicity, though some concerns remain. This review summarizes the novel data on the ICIs for resectable EC and lists the registered related clinical trials. Hopefully, this review can provide a reference for ongoing research on the treatment options for resectable EC.
Humans ; Esophageal Neoplasms/pathology* ; Esophagogastric Junction/pathology* ; Neoadjuvant Therapy/methods* ; Adenocarcinoma/drug therapy* ; Immunotherapy

Humans ; Biopsy, Fine-Needle ; Carcinoma/pathology* ; Esophagogastric Junction/pathology* ; Cytodiagnosis ; DNA Helicases ; Nuclear Proteins ; Transcription Factors

TNM staging is essential for clinical decision-making and prognostic prediction for patients with gastric cancer. The 7th TNM staging manual was formulated in 2009 and implemented in 2010. However, it was published that there were some deficiencies of the 7th edition of gastric cancer TNM staging system in clinical application process, and this old staging system could not meet the clinical needs. With the cooperation and promotion of the American Joint Committee on Cancer (AJCC), the International Union for Cancer Control (UICC) and the International Gastric Cancer Association (IGCA), and through the accumulation and analysis of gastric cancer big data, the 8th TNM staging system was published at the end of 2016. The updated staging system has defined the selection of staging system for esophagogastric junction cancer. It also has divided N3 into N3a and N3b, which has been incorporated into the new staging system, leading to more accurate risk stratification. Moreover, the cTNM staging system and ypTNM staging system have been added in the new staging manual. Overall, the 8th TNM staging system can facilitate more reasonable decision-making, more accurate prognostic prediction and better evaluation of therapeutic strategy. It is of high value to promote diagnostic and therapeutic standard for gastric cancer.
Clinical Decision-Making ; Esophagogastric Junction ; pathology ; Humans ; Neoplasm Staging ; standards ; Prognosis ; Stomach Neoplasms ; classification

Capsule endoscopy can be a diagnostic option for patients with esophageal diseases who cannot tolerate esophagogastroduodenoscopy.Functional modifications of the capsule allow for thorough examination of the esophagus. Esophageal capsule endoscopy has so farfailed to show sufficient performance to justify the replacement of traditional endoscopy for the diagnosis of esophageal diseasesbecause the esophagus has a short transit time and common pathologies appear near the esophagogastric junction. However,technological improvements are being introduced to overcome the limitations of capsule endoscopy, which is expected to become agood alternative to conventional endoscopy.
Barrett Esophagus ; Capsule Endoscopy* ; Diagnosis ; Endoscopy ; Esophageal and Gastric Varices ; Esophageal Diseases ; Esophagogastric Junction ; Esophagus ; Humans ; Pathology

The electrophysiological activity of the gastrointestinal tract and the mechanical anti-reflux structure of the gastroesophageal junction are the basis of the anti-reflux function of the stomach. Proximal gastrectomy destroys the mechanical structure and normal electrophysiological channels of the anti-reflux. Therefore, the residual gastric function is disordered. Moreover, gastroesophageal reflux is one of the most serious complications. The emergence of various types of anti-reflux surgery through the mechanism of reconstructing mechanical anti-reflux barrier and establishing buffer zone, and the preservation of, the pacing area and vagus nerve of the stomach, the continuity of the jejunal bowel, the original gastroenteric electrophysiological activity of the gastrointestinal tract, and the physiological function of the pyloric sphincter, are all important measures for gastric conservative operations. There are many types of reconstructive approaches after proximal gastrectomy. The design based on the anti-reflux mechanism and the functional reconstruction of mechanical barrier, and the protection of gastrointestinal electrophysiological activities are important considerations for the selected of reconstructive approaches after proximal gastrectomy. In clinical practice, we should consider the principle of individualization and the safety of radical resection of tumor to select a rational reconstructive approaches after proximal gastrectomy.
Humans ; Stomach Neoplasms/surgery* ; Gastrectomy ; Gastroesophageal Reflux ; Esophagogastric Junction/surgery* ; Pylorus/pathology*

Objective: To compare the prognostic influence and postoperative pathology of different comprehensive treatment models for adenocarcinoma of esophagogastric junction. Methods: Between January 2012 and December 2017, a total of 219 patients with adenocarcinoma of esophagogastric junction underwent surgery in Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute and were enrolled in this study. The clinicopathological data of these patients were collected. The patients were categorized into 3 groups according to different treatment models: surgery-first group, neoadjuvant chemotherapy (NAC) group and neoadjuvant chemoradiotherapy (nCRT) group. A trimatch propensity score analysis was applied to control potential confounders among the three groups by using R language software. A total of 7 covariates including gender, age, comorbidity, body mass index, clinical T stage, clinical N stage and Siewert type were included, and the caliper value was taken as 0.2. After matching, a total of 87 patients were included for analysis with 27 patients for each group. There were 82 males and 5 females, with a median age of 63 years (range: 38 to 76 years). The effect of preoperative treatment on postoperative tumor pathology among the three different comprehensive treatment models was explored by χ² test, ANOVA or Wilcoxon rank sum test. Mann-Whitney U test or χ² test were used to undergo pairwise comparisons. Kaplan-Meier method and Log-rank test were used to analyze the overall survival and progression-free survival. Results: The proportion of vascular embolism in the surgery-first group was 72.4% (21/29), which was significantly higher than NAC group (37.9% (11/29), χ²=6.971, P=0.008) and nCRT group (6.9% (2/29), χ²=26.696, P<0.01). The proportions of pathological T3-4 stage in nCRT group and NAC group were 55.2% (16/29) and 62.1% (18/29), respectively, which were significantly lower than the surgery-first group (93.1% (27/29), χ²=10.881, P=0.001; χ²=8.031, P=0.005). Compared with the NAC group (55.2% (16/29), χ²=6.740, P=0.009) and nCRT group (31.0% (9/29), χ²=18.196, P<0.01), the proportion of lymph node positivity 86.2% (25/29) were significantly higher in the surgery-first group. The 5-year overall survival rates were 62.1%, 68.6% and 41.4% for the surgery-first group, NAC group and nCRT group, respectively (χ²=4.976, P=0.083). The 5-year progression-free survival rates were 61.7%, 65.1% and 41.1% for the surgery-first group, NAC group and nCRT group, respectively. The differences in overall survival (χ²=4.976, P=0.083) and progression-free survival (χ²=4.332, P=0.115) among the three groups were nonsignificant. Conclusions: Postoperative pathology is significantly different among the three groups. Neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy could decrease the proportions of vascular embolism, pathological T3-4 stage and lymph node positivity to achieve local tumor control. The prognosis of overall survival and progression-free survival are not significantly different among the three groups.
Adenocarcinoma/pathology* ; Adult ; Aged ; Cohort Studies ; Esophagogastric Junction/pathology* ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Propensity Score

The occurrence of multiple primary cancers associated with the esophagus and stomach is a well known phenomenon. However, the majority of those lesions are located apart each other. Finding of esophageal cancer and gastric cancer occurring simultaneously at the esophagogastric junction is extremely rare. In this case, the endoscopic findings showed that the cancer of the gastric cardia had invaded to the lower esophagus, but after the operation, the pathology report show the synchronous occurrence of esophageal squamous cell carcinoma and gastric adenocarcinoma. Therefore, we report here on a rare case of double primary cancer, and this double primary cancer occurred at the esophagogastric junction of a 67 year-old woman.
Adenocarcinoma ; Aged ; Carcinoma, Squamous Cell ; Cardia ; Esophageal Neoplasms ; Esophagogastric Junction* ; Esophagus ; Female ; Humans ; Pathology ; Stomach ; Stomach Neoplasms

OBJECTIVETo investigate the clinical application and indication of endoscopic dissection technique for submucosal tumors (SMTs) of the esophagogastric junction (EGJ) originating from the muscularis propria.

METHODSA total of 143 SMTs of the EGJ were treated by endoscopic resection in the Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University between March 2007 and June 2011. The clinical and histopathologic feature, surgical approach, en bloc resection rate, complications, and postoperative follow up were evaluated.

RESULTSThere were 74 males and 69 females with a mean age of 49.1 years old. The en bloc resection rate was 94.4%(135/143). There were 126 patients who underwent endoscopic submucosal excavation in an en bloc fashion. Six patients underwent endoscopic full-thickness resection without laparoscopic assistance. Three patients underwent submucosal tunneling endoscopic resection. The other 8 SMTs were partially resected for histological evaluation and the residual tumors were further treated with nylon snare ligation. The mean lesion size was 17.6 mm. The mean procedure time was 45.1 minutes and the mean intraoperative bleeding was 50.0 ml. Perforations occurred in 6 patients and metal clips were used to close the defect. One patient with Mallory-Weiss syndrome was successfully treated with conservative treatment. Pathological examination showed that the lesions were leiomyoma (n=121), gastrointestinal stromal tumor (n=20), granulosa cell tumor (n=1), and intermuscular lipoma (n=1). No local recurrence and distant metastasis were noted during the follow-up (range, 3-48 months).

CONCLUSIONEndoscopic resection technique is safe and effective, and should be selected for each patient individually.

Adenocarcinoma ; surgery ; Adult ; Aged ; Endosonography ; Esophagogastric Junction ; pathology ; Female ; Follow-Up Studies ; Gastroscopy ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies