Cytokeratin phenotyping does not help in distinguishing oesophageal adenocarcinoma from cancer of the gastric cardia.
BACKGROUND
It is sometimes difficult to distinguish between cardia cancer and oesophageal cancer.


OBJECTIVE
To evaluate whether cytokeratin (CK) expression of the tumour can be of value in differentiating between the two tumour types.


METHODS
Consecutive patients with a malignant tumour in the oesophagus or stomach were recruited. Biopsy specimens were taken for routine haematoxylin and eosin staining. One tissue block with representative tissue was selected for immunohistochemical staining (CK7 and CK20).


RESULTS
Endoscopically located adenocarcinoma of the oesophagus was present in 84 patients (64 men, 20 women; mean age, 68 years; range, 44-91). Cancer located primarily in the gastric cardia was present in 63 patients (42 men, 21 women; mean age, 68 years; range, 42-88). The histological diagnosis was metastasis from a primary tumour outside the oesophagus or stomach in 19 patients. The patients were divided into three groups for the immunohistochemical analysis. Patients in group A had definite oesophageal cancer, group B patients had a definite carcinoma located in the gastric cardia, and group C patients had an obstructing tumour distal in the oesophagus at the level of the diaphragm, which could not be passed with the endoscope. Paraffin wax embedded material was available from 122 patients for immunostaining and CK analysis. There was no significant difference in expression or distribution of CK7 or CK20 in the three groups of patients.


CONCLUSIONS
CK phenotyping cannot distinguish between cancer arising from a Barrett's oesophagus and carcinoma originating in the gastric cardia.
van Lier
M G F
MG
Department of Internal Medicine, De Heel Zaans Medisch Centrum, 1500 EE Zaandam, The Netherlands.
Bomhof
F J
FJ
Leendertse
I
I
Flens
M
M
Balk
A T
AT
Loffeld
R J L F
RJ
D000230:Adenocarcinoma / Q000175:diagnosis / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000378:metabolism; D002299:Cardia; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D007633:Keratins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000378:metabolism; D011230:Precancerous Conditions / Q000175:diagnosis / Q000378:metabolism; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000378:metabolism
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D007633:Keratins