title: Adenocarcinoma of the esophagogastric junction: could the characteristics of adjacent intestinal metaplasia help in the understanding of biopathogenesis?
abstract: We report a case of early adenocarcinoma arising in foci of intestinal metaplasia (IM) at a normal-appearing gastroesophageal junction (GEJ). The tumor infiltrated the submucosa without nodal involvement (T1N0). Non-neoplastic mucosa adjacent to neoplasia had foci of incomplete IM with a band-like CK20 positivity of the surface epithelium and a diffuse CK7 staining of both superficial and deep glands. There were histological features of reflux esophagitis as well as chronic non-atrophic, Helicobacter pylori-related pangastritis, without IM, at the extensively assessed gastric mucosa. In this case, the CK7/20 pattern of IM adjacent to neoplasia, the demonstration of reflux esophagitis, and the absence of IM in the stomach favor the theory that the pathogenesis of IM and associated adenocarcinoma of the GEJ is related to gastroesophageal reflux rather than H. pylori infection.
authors.affiliation: Department of Pathology, Instituto Português de Oncologia de Francisco Gentil, Lisbon, Portugal.
authors.forename: R Adame
authors.initials: RA
authors.lastname: Cabrera
authors.forename: P
authors.initials: P
authors.lastname: Chaves
authors.forename: M
authors.initials: M
authors.lastname: Crespo
authors.forename: A Dias
authors.initials: AD
authors.lastname: Pereira
authors.forename: J C
authors.initials: JC
authors.lastname: Mendes de Almeida
authors.forename: C
authors.initials: C
authors.lastname: Nobre Leitão
authors.forename: J
authors.initials: J
authors.lastname: Soares
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000368:Aged; D002299:Cardia / Q000378:metabolism / Q000473:pathology*; D002908:Chronic Disease; D004943:Esophagogastric Junction / Q000378:metabolism / Q000473:pathology*; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008297:Male; D008679:Metaplasia / Q000473:pathology; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery
chemical_list: D007633:Keratins