title: Esophagogastric metaplasia relates to nodal metastases in adenocarcinoma of esophagus and cardia.
abstract: BACKGROUND
  Immunohistochemical profiles of esophageal and cardia adenocarcinoma differ according to the presence or absence of Barrett's epithelium (BIM) and gastric intestinal metaplasia (GIM) in the fundus and antrum. Different lymphatic spreading has been demonstrated in esophageal adenocarcinoma. We investigated the correlation among the presence or absence of intestinal metaplasia in the esophagus and stomach and lymphatic metastases in patients who underwent radical surgery for esophageal and cardia adenocarcinoma.
  
  
  METHODS
  The mucosa surrounding the adenocarcinoma and the gastric mucosa were analyzed. The BIM+ patients underwent subtotal esophagectomy and gastric pull up, and the BIM- patients underwent esophagectomy at the azygos vein, total gastrectomy, and esophagojejunostomy. The radical thoracic (station numbers 2, 3, 4R, 7, 8, and 9) and abdominal (station numbers 15 through 20) lymphadenectomy was identical in both procedures except for the greater curvature.
  
  
  RESULTS
  One hundred ninety-four consecutive patients were collected in three major groups: BIM+/GIM-, 52 patients (26.8%); BIM-/GIM-, 90 patients (46.4%); BIM-/GIM+, 50 patients (25.8%). Two patients (1%) were BIM+/GIM+. A total of 6,010 lymph nodes were resected: 1,515 were recovered in BIM+, 1,587 in BIM-/GIM+, and 2,908 in BIM-/GIM- patients. The percentage of patients with pN+ stations 8 and 9 was higher in BIM+ (p=0.001), and the percentage of patients with pN+ perigastric stations was higher in BIM- (p=0.001). The BIM-/GIM- patients had a number of abdominal metastatic lymph nodes higher than did the BIM-/GIM+ patients (p=0.0001).
  
  
  CONCLUSIONS
  According to the presence or absence of BIM and GIM in the esophagus and cardia, adenocarcinoma correspond to three different patterns of lymphatic metastasization, which may reflect different biologic and carcinogenetic pathways.
authors: Division of Thoracic Surgery, Centre for the Study and Therapy of Diseases of the Esophagus, GVM Care and Research, Department of Medical and Surgical Sciences (DIMEC), and Pathology Unit, Felice Addarii Institute, University of Bologna, Italy.
authors: Alberto
authors: A
authors: Ruffato
authors: Sandro
authors: S
authors: Mattioli
authors: Ottorino
authors: O
authors: Perrone
authors: Marialuisa
authors: M
authors: Lugaresi
authors: Massimo Pierluigi
authors: MP
authors: Di Simone
authors: Antonietta
authors: A
authors: D'Errico
authors: Deborah
authors: D
authors: Malvi
authors: Maria Rosaria
authors: MR
authors: Aprile
authors: Giandomenico
authors: G
authors: Raulli
authors: Luca
authors: L
authors: Frassineti
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D000368:Aged; D000714:Anastomosis, Surgical; D001471:Barrett Esophagus / Q000209:etiology* / Q000473:pathology; D002299:Cardia; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004947:Esophagus / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007583:Jejunum / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed