Primary adenocarcinoma of the esophagus

Of 163 patients with carcinomas of the esophagus seen between 1975 and 1982, 11 (6.7%) had a primary adenocarcinoma. Although the high ratio of men to women (10:1) was similar to that seen in patients with squamous cell carcinoma of the esophagus, the mean age of those with adenocarcinoma was younger (57 years). In contrast to squamous cell carcinomas, which predominantly involve blacks, esophageal adenocarcinomas in these patients involved only Caucasians. The great majority of lesions were found in the lower third of the esophagus. Only 3 (27%) of the patients with adenocarcinomas gave a history of a large daily alcohol consumption and only 2 (18%) had a Barrett's esophagus. Although various combinations of surgery, chemotherapy, and radiotherapy could control the primary tumor rather well, the final results were poor. All patients have now expired; median survival time was 16 months.     

Primary adenocarcinoma of the appendix: report of five cases and review of the literature

Five patients with primary adenocarcinoma of the appendix are reported. All patients presented with symptoms resembling those of acute appendicitis or periappendicular abscess. In none of them was malignancy suspected prior to operation. It is advisable that every patient above 50 years of age presenting with symptoms of appendicitis undergo laparotomy, thus enabling a better exploration of the cecal region. If an appendiceal mass is present and frozen section shows malignancy, a right hemicolectomy should be performed. The prognosis of adenocarcinoma of the appendix is dismal as most patients present with an advanced stage of the disease.     

Esophageal adenocarcinoma arising in Barrett esophagus

The major risk factors for esophageal adenocarcinoma are gastroesophageal reflux disease (GERD) and Barrett esophagus, a squamous-to-columnar cell metaplasia that predisposes to malignancy. Adenocarcinomas in Barrett esophagus are thought to arise through a sequence of growth-promoting, genetic alterations that accumulate until the cells have acquired the physiologic hallmarks of cancer proposed by Hanahan and Weinberg. Moreover, GERD and Barrett esophagus are associated with chronic esophagitis, and inflammation is a well known risk factor for cancer formation. The cell that gives rise to Barrett metaplasia is not known. It has been proposed that the metaplasia may arise from a change in the differentiation pattern of stem cells that either reside in the esophagus or are recruited to the esophagus from the bone marrow. Alternatively, it is possible that Barrett metaplasia develops through the conversion of one differentiated cell type into another. Regardless of the cell of origin, Barrett metaplasia ultimately must be sustained by stem cells, which might be identified by intestinal stem cell markers. An emerging concept in tumor biology is that cancer stem cells are responsible for sustaining tumor growth. If Barrett cancers develop from Barrett stem cells, then a therapy targeted at those stem cells might prevent esophageal adenocarcinoma. This report reviews the risk factors for Barrett esophagus and esophageal adenocarcinoma, the mechanisms by which genetic alterations might contribute to carcinogenesis in Barrett esophagus, and the role of stem cells in the development of Barrett metaplasia and adenocarcinoma.     

Small-cell carcinoma of the esophagus: Report of three cases and review of the literature with emphasis on therapy

Primary small-cell carcinoma (SCC) of the esophagus is rare, withabout 200 cases reported up till now in the literature. Like pulmonarySCC, it is an aggressive tumor associated with a poor prognosis.Between 1994 and 1997, three patients with SCC of the esophagus weretreated at Besançon University Hospital and this represented1.85% of all esophageal malignancies diagnosed during thisperiod: one patient had a limited tumor and underwent initial surgicalresection, then chemotherapy with cisplatine and etoposide, andradiotherapy for recurrences. The other patients had extensive diseaseat diagnosis and were treated by the same chemotherapy.Thisretrospective study reports our experience of patients with thisparticular tumor and outlines the management strategy based on theavailable literature.     

Squamous cell carcinoma of the esophagus: A study of 153 cases

The incidence of esophageal carcinoma in the United States is relatively low; total estimated cases annually are about 7,000 (Ca, 1975). The overall cure rate, however, is about the worst among all the malignant diseases and is reported to be 3% (Ca, 1975). We reviewed cases of squamous cell carcinoma of the esophagus treated at Roswell Park Memorial Institute to understand the clinicopathologic features in order to improve our therapeutic results.     

Adrenal adenocarcinoma: A review of 53 cases

Problem: Fifty-three patients (30 men, 23 women) with histologically proven adrenal carcinoma were reviewed. Nineteen (36%) had endocrine manifestations from functioning tumors. Arteriography was positive in 95% (19/20), CT scan in 94% (17/18), and ultrasound in 92% (12/13). Seventy-six percent of the patients, at the time of diagnosis, were stage III and IV. Most common metastatic sites were the liver, lymph nodes, bone, and lungs. Local recurrence developed in 39% of cases (15/38). Method: Forty-one patients underwent an operation. Complete surgical removal of all gross tumor was achieved in 24 patients. Result: The overall median survival time was 8 months, and the estimated 5-year survival rate 19%. There were significant differences in survival between the various stages (P = 0.01) and between the group of patients who underwent complete excision of the tumor and those with incomplete resection (P = 0.002). Conclusions: Complete surgical excision offers the best prospect for long-term survival in localized adrenal carcinoma. © Wiley-Liss, Inc.     

Primary malignant melanoma of the esophagus: report of two cases.

Two cases of primary esophageal malignant melanoma diagnosed at the Columbia-Presbyterian Medical Center are reported. One patient who received 3800 rads and had subsequent surgery lived for 18 months. The other had surgery and subsequent chemotherapy and is still alive three years later. Forty other cases reported in the literature are briefly analyzed.     

Primary nasopharyngeal adenocarcinoma: a review

Primary nasopharyngeal adenocarcinoma (NAC) accounts for approximately 0.5% of all nasopharyngeal cancer. The diagnosis, staging and treatment of NAC has not been well described. This article presents a literature review on NAC and identifies its characteristics and management. The NAC group of diseases contains various pathological types and has a series of specific clinical characteristics, including slow progression, a low incidence of neck masses and frequent cranial neuropathy. The Epstein-Barr virus may not play an important role in NAC carcinogenesis. The rarity of the disease makes the staging classification and treatment strategies of NAC parallel to those recommended for nasopharyngeal squamous carcinoma. Some patients might benefit from surgery, and radiotherapy using precise techniques might achieve good control for treating NAC, but the roles of chemotherapy and target therapy are not clear. The proper staging system and optimal treatment strategies need to be established in NAC.     

Dietary antioxidants and risk of Barrett's esophagus and adenocarcinoma of the esophagus in an Australian population

While dietary antioxidants are emerging as potentially modifiable risk factors for esophageal adenocarcinoma (EAC), studies on dietary antioxidants and its precursor Barrett's esophagus (BE) are limited. The present study extends previous work on BE by investigating risks of nondysplastic BE, dysplastic BE and EAC associated with intake of antioxidants such as vitamin C, vitamin E, β‐carotene, and selenium. Age and sex matched control subjects (n=577 for BE; n=1,507 for EAC) were sampled from an Australian population register. Information on demography, and well established EAC risk factors were obtained using self‐administered questionnaires. Intake of antioxidants for patients newly diagnosed with nondysplastic BE (n=266), dysplastic BE (n=101), or EAC (n=299), aged 18–79 years, were obtained using a food frequency questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable adjusted logistic regression models. High intake of β‐carotene from food and supplement sources combined was inversely associated with risk of dysplastic BE (OR Q4 vs. Q1=0.45; 95%CI: 0.20–1.00). High intake of vitamin E from food sources (OR Q4 vs. Q1=0.43; 95%CI: 0.28–0.67), from food and supplements combined (OR Q4 vs. Q1=0.64; 95%CI: 0.43–0.96), and a high antioxidant index score were inversely associated with risk of EAC. We found no significant trends between intake of β–carotene, vitamin C, vitamin E, and selenium and risk of nondysplastic or dysplastic BE. However, our data suggest that a high intake of β‐carotene may be associated with decreased risk of dysplastic BE.     

Risk factors for the development of an adenocarcinoma in columnar-lined (Barrett) esophagus

Background. To evaluate the importance of the length of columnar-lined esophagus, sex, age, smoking, and drinking habits as risk factors for malignant degeneration, the authors performed a retrospective case-control study comparing patients with and without adenocarcinoma in Barrett esophagus. Methods. The records of 96 patients (53 male and 43 female; mean age, 61 years) with a benign columnar-lined esophagus and 62 patients (47 male and 15 female; mean age, 62 years) with an adenocarcinoma in columnar-lined esophagus referred to the Rotterdam Esophageal Tumor Study Group, diagnosed over the same period (1978–1985), were reviewed. A frequency distribution of the length of columnar-lined esophagus in both groups was made. Statistical analysis was performed with multivariate methods. Results. The length of columnar-lined esophagus was related significantly to carcinoma: a doubling of the length resulted in a 1.7 times increased risk. Smokers had a 2.3-fold increased risk as compared with nonsmokers. Male sex as a risk factor approached statistical significance (P = 0.06). Adjusted for these risk factors, no relation between carcinoma and age or alcohol consumption was found. Conclusions. The risk of development of an adenocarcinoma in Barrett esophagus increased with the length of Barrett epithelium. Smoking and possibly male sex were also risk factors. The identification of these risk factors may help in developing more efficient screening programs for patients with Barrett esophagus.     

原发性食管腺癌45例临床病理分析

目的 :了解原发性食管腺癌的生物学特性 ,探讨合理的综合治疗措施。方法 :对 4 5例原发性食管腺癌患者的临床病理资料进行回顾性分析。结果 :其中食管单纯腺癌 32例 ,腺鳞癌 13例 ,1、3、5年生存率分别为 71 1%、53 1%和 4 7 0 %。结论 :因食管腺癌粘膜下浸润能力强 ,恶性程度高 ,有早期扩散和转移倾向 ,预后差 ,手术是其首选的主要治疗手段 ,以胸段食管全切、食管胃端侧颈部吻合术为宜 ,同时应最大限度的清除区域淋巴结     

单纯Barrett's食管腺癌108例临床分析

目的分析单纯Barrett’s食管腺癌根治性手术切除后加用放、化疗的临床疗效,探讨影响Barrett’s食管腺癌预后的因素。方法回顾性分析108例Barrett’s食管腺癌患者的临床资料及随访结果。行根治性手术切除者92例,其中术后单纯放疗者76例,术后放疗后加用化疗者16例;姑息性手术治疗者16例,其中有4例患者于术中死亡,另12例患者在术后均采用放疗 化疗。放疗采用60钴或6MV-X线,体外常规分割照射,靶区放射治疗总剂量为55～70 Gy;化疗采用FAM或CMF方案4～6个疗程。结果采用Kaplan-Meier法计算其生存率,本组患者1、3、5年生存率分别为81.5%、51.9%和22.2%,其中根治性手术切除后单纯放疗者5年生存率为15.8%,术后放疗加化疗者为75.0%;有肿瘤外侵者5年生存率为9.1%,无肿瘤外侵者为33.3%;有淋巴结转移者5年生存率为14.3%,无淋巴结转移者为33.3%;姑息性手术治疗术后加放、化疗后5年生存率为0。Log rank检验结果显示,差异均有统计学意义(P<0.05)。结论单纯Barrett’s食管腺癌根治性手术切除后,及时加用放、化疗治疗,有助于疗效的提高。影响预后的主要因素为临床分期、肿瘤外侵、淋巴结转移和根治性手术切除后放、化疗措施的应用。     

Primary gastric adenocarcinoma in a 2.5-year-old girl

Primary gastric adenocarcinoma is extremely rare in children. Here, we report an additional case of primary adenocarcinoma, located at the lesser curvature in a girl at the age of 2.5 years. She had no family history and no apparent underlying cause for the tumor. She died 4 months after admission despite complete resection of the mass and chemotherapy. Received: January 10, 2002 / Accepted: August 6, 2002 Offprint requests to: H. ?ztürk     

Comparative analysis of clinical,treatment, and survival characteristics of signet ring cell and adenocarcinoma of esophagus

BackgroundSignet ring cell carcinoma (SRC) is a rare pathological subtype of mucinous adenocarcinoma (AC). Clinical features, prognosis, and especially treatment methods between SRC and AC of the esophagus remain controversial. Thus, we conducted this study to explore the differences in clinicopathological characteristics and treatment modalities between SRC and AC of the esophagus.MethodsA retrospective cohort study based on the Surveillance, Epidemiology, and End Results (SEER) program database was conducted. Patients diagnosed with SRC or AC not otherwise specified (NOS) were selected between 2004 and 2018. We investigated the prognosis of SRC and AC in terms of overall survival (OS). A subgroup analysis was performed according to the stage and different treatment methods.ResultsA total of 24,987 patients were enrolled, including 1,147 with SRC and 23,840 with AC. In the multivariate Cox analysis of the whole cohort, SRC, tumor site, differentiation, metastases, American Joint Committee on Cancer (AJCC) 6th edition staging, treatment, tumor size, lymph nodes examined, and positive lymph nodes were independent risk factors. The results of the subgroup analysis showed that surgery alone was associated with better OS for AC at the early stage, but was not significantly different for SRC (P=0.896). Surgery plus adjuvant therapy was the best treatment for SRC and AC at the late stage. In the multivariate Cox analysis, the treatment of surgery plus adjuvant therapy had a tendency towards better OS at the early stage [hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.39–1.1, P=0.08].ConclusionsSRC is an independent risk factor, with a higher grade of differentiation, later stage, larger tumor size, more positive lymph nodes, and poorer prognosis compared with AC. Surgery plus adjuvant therapy seems to be useful for SRC at the early stage, but further research is needed.     

Results of surgical therapy in patients with adenocarcinoma of the esophagus and cardia

Background. Adenocarcinoma of the esophagus and cardia is a challenging disease for the surgeon. Delay in diagnosis, nodal involvement, and incompleteness of resection have an adverse effect on long-term prognosis. Efforts are currently oriented to identify patients who may benefit from extensive resection. Methods. Between November 1992 and May 1998, 218 patients with histologically proven adenocarcinoma of the distal esophagus or cardia were referred to our Department. In 6 patients (10.2%) cancer was discovered during endoscopic surveillance for Barrett's metaplasia. Overall, 147 patients (67%) underwent resection. An Ivor-Lewis approach was used in 121 patients; of these, 51 underwent an extended mediastinal lymph node dissection. Results. Median cumulative survival was 25.9 ± 3.1 months in patients undergoing resection, and 7 ± 1.3 months in patients having palliation (P < 0.01). Survival was significantly higher in patients with negative nodes than in those with lymph node metastases (54 ± 12.9 versus 17 ± 2.8 months; P < 0.01). Six of the 51 patients (11.8%) undergoing extended lym-phadenectomy had metastatic upper mediastinal nodes. Additional serial sections and immunohistochemistry were performed in 46 patients. In 6 of 18 patients (33.3%) with negative nodes at conventional hematoxylin-eosin examination, immunohistochemistry demonstrated micrometastases in the lesser curvature, paracardial, peripancreatic, or lower mediastinal nodes. Three of these patients had recurrent disease within the first year of follow-up. Conclusions. Early diagnosis remains the prerequisite for curative treatment of adenocarcinoma of the esophagus and cardia. Endoscopic surveillance appears to be warranted in patients with Barrett's metaplasia. When a curative resection is attempted, extended lymphadenectomy improves tumor staging and may prevent local recurrences. Serial sections and immunohistochemistry provide additional accuracy in the staging of the disease and may prove useful to select patients for adjuvant therapy. Received for publication on Sept. 3, 1998; accepted on March 3, 1999     

原发性食管腺癌——附外科治疗27例报告

 本文报告原发性食管腺癌27例,占同期食管癌的1.1%(27/2456)。27例全部施行了手术切除,术后一、二、三、四年生存率分别为66.7%(18/27)、34.6%(9/26)、19.0(4/21)和7.7%(1/13),无五年生存者。疗效较食管鳞癌显著为未食管腺癌组织来源有三种:食管本身腺体、食管的异位胃粘膜、Barrett食管。组织学分四种类型:单纯性腺癌、腺鳞癌、表皮粘液样癌和囊性腺样癌,其中以单纯性腺癌和腺鳞病占绝大多数(26/27)。食管腺癌的诊断须有病理检查证实。早期手术是首选治疗方法。     

Primary undifferentiated small cell carcinoma of the esophagus: clinicopathological and flow cytometric evaluation of eight cases

We present a clinicopathological and flow cytometric evaluation of eight primary small cell carcinomas of the esophagus representing 1.5% of all esophageal malignancies diagnosed during a 22-year period (1965-1987) in the Tampere University Central Hospital. The mean age of the patients (four male and four female) was 67 years (range 55-75 years). Five cases had distant metastases at the time of diagnosis. Three patients were treated by esophageal resection, one by laser vaporisation, and four by chemotherapy. The median survival time was 4 months (range 9 days to 8 months). A complete local response to chemotherapy in serial esophagogramms was detected in one patient. All four patients given chemotherapy survived longer than those treated with esophageal resection only. Four (67%) of the six carcinomas analyzed by DNA flow cytometry contained DNA-aneuploid stemlines. The median S-phase fraction of these small cell carcinomas was high (16.3%), reflecting rapid cell proliferation rate, which may be related to their responsiveness to chemotherapy.