Histological differences in the invasion of advanced esophageal and gastric carcinoma beyond the esophago-gastric junction.

Abstract

BACKGROUND: The esophago-gastric junction (EGJ) has several unique anatomical and histological features. We investigated the histological differences between esophageal squamous cell carcinoma with invasion of the gastric wall (esophageal group of patients) and gastric carcinoma with invasion of the esophageal wall (gastric group of patients).METHODS: Thirty-six patients in the esophageal group and 83 patients in the gastric group were histologically examined in regard to the mode of invasion. The pattern of tumor invasion beyond the EGJ was classified as continuous or discontinuous.RESULTS: The discontinuous pattern was more frequently seen in the esophageal group than in the gastric group. In the gastric group, however, the distance invaded beyond the EGJ was significantly greater in tumors with the discontinuous pattern than in those with the continuous pattern ( P < 0.01). Gastric mucosal invasion at the EGJ was not seen in 36% of the esophageal group, whereas tumor infiltration into the esophageal mucosal layer at the tip beyond the EGJ was found in 60% of the gastric group. The incidence of invasion deeper than the muscularis propria in the gastric and esophageal groups was 18% and 58%, respectively ( P < 0.0001).CONCLUSION: The histological characteristics of esophageal or gastric carcinoma beyond the EGJ should be taken into consideration in diagnosis and surgical procedures.