title: Adenocarcinomas of the distal esophagus and "gastric cardia" are predominantly esophageal carcinomas.
abstract: BACKGROUND
  Adenocarcinoma of the distal esophagus and gastric cardia are defined by the relationship of its epicenter to the gastro-esophageal junction, which is presently defined as the end of the tubular esophagus. We have recently suggested that the true gastro-esophageal junction is best defined by the proximal limit of gastric oxyntic mucosa.
  
  
  OBJECTIVE
  To reclassify adenocarcinomas of this region by the relationship of the tumor to the proximal limit of gastric oxyntic mucosa.
  
  
  METHODS
  Seventy-four patients who had esophago-gastrectomy for adenocarcinomas in this region were classified as adenocarcinoma of distal esophagus (38 patients) and gastric cardia (36 patients) by present criteria. The epithelial type at the epicenter and distal edge of these tumors was assessed.
  
  
  RESULTS
  The epicenter of the tumor in 64 patients with noncircumferential tumors had squamous (5 cases), cardiac (21 cases), oxynto-cardiac (4 cases), and intestinal (Barrett-type) (34 cases) epithelia. None had gastric oxyntic mucosa. Of the 10 patients with circumferential tumors, 7 had cardiac or oxynto-cardiac epithelium at the distal tumor edge.
  
  
  CONCLUSIONS
  If the gastro-esophageal junction is defined histologically as the proximal limit of oxyntic mucosa, 71/74 patients would be classified as adenocarcinoma of the distal esophagus. The other 3 patients were questionable as to gastric or esophageal origin. We suggest that this reclassification based on the proposed new definition of the gastro-esophageal junction provides an explanation for the epidemiologic relationship that exists between adenocarcinoma of the "gastric cardia" and gastro-esophageal reflux disease.
authors.affiliation: Department of Surgical Pathology, Keck School of Medicine and University of Southern California, Los Angeles, CA 90033, USA. ptchandr@usc.edu
authors.forename: Parakrama
authors.initials: P
authors.lastname: Chandrasoma
authors.forename: Kumari
authors.initials: K
authors.lastname: Wickramasinghe
authors.forename: Yanling
authors.initials: Y
authors.lastname: Ma
authors.forename: Tom
authors.initials: T
authors.lastname: DeMeester
mesh_terms: D000230:Adenocarcinoma / Q000145:classification* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology; D002299:Cardia / Q000473:pathology; D004938:Esophageal Neoplasms / Q000145:classification* / Q000473:pathology*; D004942:Esophagitis, Peptic / Q000473:pathology; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged