Junction Tumors Research Articles

Esophageal Neuroendocrine Carcinoma Presenting as a Rare Cause of Dysphagia

Introduction: Neuroendocrine carcinomas comprise 0.4-2.0% of all esophageal malignancies and are a rare cause of dysphagia. The prognosis is generally poor as the tumor is usually advanced at the time of symptomology and diagnosis. The following is a case of a 60-year-old male patient with solid food dysphagia found to have a large, friable, gastroesophageal junction tumor during esophagogastroduodenoscopy (EGD). Biopsies confirmed a high-grade neuroendocrine carcinoma with a Ki-67 (proliferative index) of 90%.Figure: Frond-like esophageal tumor seen in the distal esophagus.Figure: Large ulcerated tumor extending into the gastric cardia, retroflex view.Figure: Neuroendocrine carcinoma consisting of a poorly differentiated, high-grade malignant neoplasm of intermediate to large cells with a trabecular architecture resembling neuroendocrine tumor within gastric mucosa (magnification 100x).Case: A 60-year-old male presented with a six-month history of daily solid food dysphagia and a 10lb intentional weight loss. His past medical history was significant for stage 1 squamous cell carcinoma of the larynx diagnosed four years prior and treated with chemotherapy. He had a 30 pack-year smoking history and continued to smoke half a pack of cigarettes daily. His only medication was an ipratropium/albuterol 20-100mg inhaler for chronic obstructive pulmonary disease. EGD demonstrated a large frond-like villous tumor occupying 50% of the circumference of the distal third of the esophagus extending 3cm proximal of the Z-line (figure 1). There was a pseudo lumen within the tumor that led into the stomach, and on retroflexed view there was a 5 cm ulcerated tumor extending into the cardia (figure 2). Biopsy results showed squamous and oxyntic-gastric mucosa containing sheets and packets of pleomorphic cells (figure 3). The cells demonstrated variable immunohistochemical positivity for synaptophysin, chromogranin and CD56. Immunohistochemistry for Ki-67 revealed a proliferation index of greater than 90%, classifying the tumor as Grade 3 or high-grade neuroendocrine carcinoma, denoting poor prognosis per the current National Comprehensive Cancer Network guidelines. Subsequent computed tomography supported findings of a 7.1 x 6.8 x 4.8 cm gastroesophageal junction mass with prominent regional lymph nodes without distant metastasis. The patient was treated with neoadjuvant chemotherapy of cisplatin, etoposide, and dexamethasone and concurrent radiation therapy prior to surgical resection. Discussion: Esophageal neuroendocrine tumors are a very rare cause of dysphagia and represent 0.4-2.0% of all esophageal malignancies. They are not well known by gastroenterologists and present as a mimicker of esophageal adenocarcinoma. Poorly differentiated (high-grade) extrapulmonary neuroendocrine carcinomas are not well-defined or documented frequently within the medical literature. National cancer guidelines suggest a treatment similar to small-cell lung cancer with platinum-based chemotherapy and radiation therapy either as neoadjuvant therapy or palliative therapy if metastatic disease is present. Generally, there is a poor prognosis of esophageal neuroendocrine tumors due to the advanced nature at diagnosis, but in the absence of metastatic disease, are treated with curative intent.

A Diagnosis to Make You Salivate: The Curious Case of a Gastroesophageal Junction Tumor

A Diagnosis to Make You Salivate: The Curious Case of a Gastroesophageal Junction Tumor

Dosimetric comparison to the heart and cardiac substructure in a large cohort of esophageal cancer patients treated with proton beam therapy or Intensity-modulated radiation therapy

PurposeTo compare heart and cardiac substructure radiation exposure using intensity-modulated radiotherapy (IMRT) vs. proton beam therapy (PBT) for patients with mid- to distal esophageal cancer who received chemoradiation therapy. Methods and materialsWe identified 727 esophageal cancer patients who received IMRT (n=477) or PBT (n=250) from March 2004 to December 2015. All patients were treated to 50.4Gy with IMRT or to 50.4 cobalt Gray equivalents with PBT. IMRT and PBT dose–volume histograms (DVHs) of the whole heart, atria, ventricles, and four coronary arteries were compared. For PBT patients, passive scattering proton therapy (PSPT; n=237) and intensity-modulated proton therapy (IMPT; n=13) DVHs were compared. ResultsCompared with IMRT, PBT resulted in significantly lower mean heart dose (MHD) and heart V5, V10, V20, V30, and V40as well as lower radiation exposure to the four chambers and four coronary arteries. Compared with PSPT, IMPT resulted in significantly lower heart V20, V30, and V40 but not MHD or heart V5 or V10. IMPT also resulted in significantly lower radiation doses to the left atrium, right atrium, left main coronary artery, and left circumflex artery, but not the left ventricle, right ventricle, left anterior descending artery, or right coronary artery. Factors associated with lower MHD included PBT (P<0.001), smaller planning target volume (PTV; P<0.001), and gastroesophageal junction (GEJ) tumor (P<0.001). Among PBT patients, factors associated with lower MHD included IMPT (P=0.038), beam arrangement other than AP/PA (P<0.001), smaller PTV (P<0.001), and GEJ tumor (P<0.001). ConclusionsIn patients with mid- to distal esophageal cancer, PBT results in significantly lower radiation exposure to the whole heart and cardiac substructures than IMRT. Long-term studies are necessary to determine how this cardiac sparing effect impacts the development of coronary artery disease and other cardiac complications.

Surgical approaches, anaesthetic management and outcome in pediatric superior mediastinal tumors

BackgroundPediatric superior mediastinal tumors are a heterogeneous group of tumors with marked variation in pathology and extension. We reviewed our experience with different surgical approaches to tumors originating from or extending to superior mediastinum in pediatrics. Patients and methodsThe medical records of all patients who had undergone resection for superior mediastinal tumors in Children's Cancer Hospital – Egypt, between January 2008 to December 2015, were reviewed for demographic data, clinico-pathological features, radiologic findings, operative techniques and outcome. ResultsThe study included 20 patients. Diagnosis included: germ cell tumors (n=8), neuroblastoma (n=4), soft tissue sarcoma (n=3), thymolipoma (n=2), infantile fibromatosis (n=1), calcifying fibrous tumor (n=1), and thymic carcinoma (n=1). Tumor extension was divided into tumors extending unilaterally to one hemithorax (n=9), tumors extending bilaterally to both hemithoraces (n=4), and cervico thoracic junction tumors (n=7). Extended lateral thoracotomy was used in 8 patients. Other approaches included trapdoor (n=5), clamshell (n=4), cervical approach (n=2) and double level lateral thoracotomy (n=1). There was no perioperative mortality, and postoperative morbidity was 20%. At the end of December 2016, 15 patients were alive free of disease, 5 patients developed local and/ or distant relapse. ConclusionPediatric superior mediastinal tumors could be divided into 3 groups according to tumor extension. Each group has an optimum surgical approach that achieves the best exposure for adequate resection. However, further research is needed to confirm the conclusion as this was a descriptive study and the sample size was too small for valid statistical analysis.

Prophylactic tributyrin treatment mitigates chronic-binge ethanol-induced intestinal barrier and liver injury.

Impaired gut-liver axis is a potential factor contributing to alcoholic liver disease. Ethanol depletes intestinal integrity and causes gut dysbiosis. Butyrate, a fermentation byproduct of gut microbiota, is altered negatively following chronic ethanol exposure. This study aimed to determine whether prophylactic tributyrin could protect the intestinal barrier and liver in mice during combined chronic-binge ethanol exposure. C57BL/6J mice exposed to 5% v/v ethanol-containing diet for 10days received a single ethanol gavage (5g/kg) 9h before euthanasia. Control mice were isocalorically pair-fed maltose dextrin for ethanol. Diets were supplemented (5mM) with tributyrin or glycerol. Intestine and liver disease activity was assessed histologically. Protein and mRNA expression of tight junction (TJ) proteins, toll-like receptors, and tumor necrosis factor-alpha were assessed. Caco-2 monolayers with or without ethanol exposure and/or sodium butyrate were used to test butyrate's direct effects on intestinal integrity. Chronic-binge ethanol feeding impaired intestinal TJ protein co-localization staining; however, tributyrin co-treatment mitigated these effects. Ethanol depleted TJ and transepithelial electrical resistance in Caco-2 monolayers, but butyrate co-treatment reduced these effects. Hepatic toll-like receptor mRNA expression and tumor necrosis factor-alpha protein expression was induced by ethanol; however, the response was significantly dampened in mice co-treated with tributyrin. Tributyrin altered localization of both neutrophils and single hepatocyte death: Leukocytes and apoptotic hepatocytes localized predominantly around the portal tract in ethanol-only treated mice, whereas localization predominated around the central vein in ethanol-tributyrin mice. Prophylactic tributyrin supplementation mitigated effects of combined chronic-binge ethanol exposure on disruption of intestinal TJ localization and intestinal permeability and liver injury.

Endoscopic submucosal dissection for esophagogastric junction tumors: a single-center experience.

Surgical resection for esophagogastric junction (EGJ) tumors is more aggressive and worsens the quality of life of the patients and leads to poor prognosis even after surgery compared with tumors in other sites of the stomach. Endoscopic submucosal dissection (ESD) is a widely accepted treatment modality for premalignant lesions and early cancers in the stomach. However, EGJ tumor is one of the most technically difficult lesions to resect by ESD. Therefore, this study aimed to evaluate the therapeutic outcomes of ESD for EGJ epithelial neoplasms and to assess the predictive factors for incomplete resection. We conducted a retrospective observational study of 48 patients who underwent ESD for adenomas and early cancers of the EGJ between March 2006 and November 2015 at the Pusan National University Hospital. Therapeutic outcomes of ESD and procedure-related adverse events were analyzed. En bloc resection, complete resection, and curative resection rates were 96, 77, and 71%, respectively. Multivariate analyses showed that the presence of ulceration was an independent predictive factor for incomplete resection (odds ratio 21.3, 95% confidence interval 1.51-298.49; p=0.023). The procedure-related bleeding, perforation, and stenosis rates were 8, 4, and 0%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25months (range 6-72months), local recurrence occurred in four patients with incomplete resection. ESD is an effective, safe, and feasible treatment for EGJ epithelial neoplasms. However, the complete resection rate decreases for tumors with ulceration.

Minimally Invasive Versus Open Esophageal Resection: Three-year Follow-up of the Previously Reported Randomized Controlled Trial: the TIME Trial.

The aim of this study was to investigate 3-year survival following a randomized controlled trial comparing minimally invasive with open esophagectomy in patients with esophageal cancer. Research on minimally invasive esophagectomy (MIE) has shown faster postoperative recovery and a marked decrease in pulmonary complications. Debate is ongoing as to whether the procedure is equivalent to open resection regarding oncologic outcomes. The study is a follow-up study of the TIME-trial (traditional invasive vs minimally invasive esophagectomy, a multicenter, randomized trial). Between June 2009 and March 2011, patients with a resectable intrathoracic esophageal carcinoma, including the gastroesophageal junction tumors (Siewert I), were randomized between open and MI esophagectomy with curative intent. Primary outcome was 3-year disease-free survival. Secondary outcomes include overall survival, lymph node yield, short-term morbidity, mortality, complications, radicality, local recurrence, and metastasis. Analysis was by intention-to-treat. This trial is registered with the Netherlands Trial Register, NTR TC 2452. Both trial protocol and short-term results have been published previously. One hundred fifteen patients were included from 5 European hospitals and randomly assigned to open (n = 56) or MI esophagectomy (n = 59). Combined overall 3-year survival was 40.4% (SD 7.7%) in the open group versus 50.5% (SD 8%) in the minimally invasive group (P = 0.207). The hazard ratio (HR) is 0.883 (0.540 to 1.441) for MIE compared with open surgery. Disease-free 3-year survival was 35.9% (SD 6.8%) in the open versus 40.2% (SD 6.9%) in the MI group [HR 0.691 (0.389 to 1.239). The study presented here depicted no differences in disease-free and overall 3-year survival for open and MI esophagectomy. These results, together with short-term results, further support the use of minimally invasive surgical techniques in the treatment of esophageal cancer.

Optimal minimally invasive surgical procedure for gastric submucosal tumors

Laparoscopic wedge resection (LWR) is widely performed for managing gastric submucosal tumors (SMTs). Despite the development of novel procedures such as laparoscopy-endoscopy cooperative surgery (LECS) and nonexposed endoscopic wall-inversion surgery (NEWS), the most appropriate surgical intervention for gastric SMTs remains unclear. We retrospectively reviewed patient characteristics, surgical outcomes, postoperative courses, results of histopathological examinations, and surgical costs of 71 consecutive patients who underwent LWR, LECS, or NEWS for gastric SMTs from January 2010 to June 2016 in our institute. LWR, LECS, and NEWS were performed in 31, 14, and 26 cases, respectively. Patient backgrounds were comparable between groups. LWR was not performed for esophagogastric (E-G) junction tumors to avoid postoperative stricture, and LECS was not performed for ulcerated tumors to prevent tumor dissemination. NEWS was considered for tumors smaller than 3cm for transoral extraction. Resected specimen area of the LWR group was significantly larger than that of the other groups. Further, the LWR group had a significantly higher complication rate. Compared to the LECS group, postoperative serum C-reactive protein level was significantly lower and postoperative hospitalization was significantly shorter in the NEWS group. Also, operation costs were significantly lower in the NEWS group. The surgical procedure for gastric SMTs must be carefully chosen according to tumor size, location, and presence or absence of ulceration. For selected patients, NEWS is suggested to be an appropriate option for the treatment of gastric SMTs.

Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial.

The first and only randomized trial comparing open esophagectomy (OE) with minimally invasive esophagectomy (MIE) showed a significant lower incidence of post-operative respiratory infections in the patients who underwent MIE. In order to identify which specific factors are related to a better respiratory outcome in this trial an additional analysis was performed. This was a prospective, multicenter, randomized controlled trial. Eligible patients, with a resectable intrathoracic esophageal carcinoma, including the gastro-esophageal (GE) junction tumors and Eastern Cooperative Oncology Group ≤2, were randomized to either MIE or OE. Respiratory infection investigated was defined as a clinical manifestation of (broncho-) pneumonia confirmed by thorax X-ray and/ or Computed Tomography scan and a positive sputum culture. A logistic regression model was used. From 2009 to 2011, 115 patients were randomized in 5 centers. Eight patients developed metastasis during neoadjuvant therapy or had an irresectable tumor and were therefore excluded from the analysis. Fifty-two OE patients were comparable to 55 MIE patients with regard to baseline characteristics. In-hospital mortality was not significantly different [2% (open group) and 4% (MIE group)]. A body mass index (BMI) ≥26 and OE were associated with a roughly threefold risk of developing a respiratory infection. Overweight patients and OE are independently associated with a significant higher incidence of post-operative respiratory infections, i.e., pneumonia.

Gastro-esophageal junction cancers: what is the best minimally invasive approach?

The short-term advantages of minimally invasive esophagectomy (MIE) in terms of less morbidity and better quality of life (QoL) in comparison with open esophagectomy (OE) became visible in the last few years. There are two main MIE approaches: a transthoracic esophagectomy (TTE) (either accompanied by an intrathoracic or cervical anastomosis) or a transhiatal esophagectomy (THE) (accompanied by a cervical anastomosis). Additionally, minimally invasive gastrectomy is increasingly gaining popularity over open gastrectomy. Controversy still exists about what approach is the best for esophagogastric junction tumors (EGJ) and the choice of the approach is currently based on the surgeons' discretion. In this study, we describe the definition, staging and classification, indications for each minimally invasive approach for EGJ tumors, the surgical technique, current developments and problems regarding surgical treatment for patients with cancer of the EGJ.

Motion of gastroesophageal junction adenocarcinoma during preoperative radiotherapy

Objective To evaluate the range of motion of gastroesophageal junction (GEJ) adenocarcinoma during preoperative radiotherapy. Methods Fourteen consecutive patients who received preoperative chemoradiotherapy for GEJ adenocarcinoma were included in this study. Fiducial markers were placed on the upper and lower edges of and around the primary tumor under a gastroscope. Eight patients underwent four-dimensional computed tomography to obtain 98 intrafractional images containing 8 fiducial markers at the GEJ. Twelve patients underwent cone-beam computed tomography at the 1 st to 5th, 7th, 12th, 17th, and 22nd courses of radiotherapy to obtain 90 interfractional images. The paired t test was used for difference analysis. Results The intrafractional tumor displacements in left-right (LR), ventro-dorsal (VD), and cranio-caudal (CC) directions were 0.92±0.95 mm, 2.27±2.73 mm, and 9.95±5.48 mm, respectively; the motion in CC direction was larger than that in LR or VD direction (P=0.000 or P=0.000); the motion in VD direction was larger than that in LR direction (P=0.000). The interfractional tumor displacements in LR, VD, and CC were 6.56±4.19 mm, 5.69±3.29 mm, and 6.49±4.37 mm, respectively; the motion in LR or CC direction was larger than that in VD direction (P=0.031 or P=0.044); there was no significant difference between the motions in LR and CC directions (P=0.956). In order to ensure 95% of prescribed dose to at least 90% of the tumor volume, the margins from GEJ lesion in LR, VD, and CC directions were 19.4 mm, 14.6 mm, and 27.2 mm, respectively, which could cover both intrafractional and interfractional tumor displacements during preoperative radiotherapy. Conclusions GEJ tumor has a wide range of movement in preoperative intra-and inter-fractional radiotherapy. This should be considered for precise radiotherapy, and a new method should be selected to limit tumor movement. Key words: Gastroesophageal junction tumor; Preoperative radiotherapy; Displacement

Quantitative Shotgun Proteomics Unveils Candidate Novel Esophageal Adenocarcinoma (EAC)-specific Proteins

Esophageal cancer is the eighth most common cancer worldwide and the majority of patients have systemic disease at presentation. Esophageal adenocarcinoma (OAC), the predominant subtype in western countries, is largely resistant to current chemotherapy regimens. Selective markers are needed to enhance clinical staging and to allow targeted therapies yet there are minimal proteomic data on this cancer type. After histological review, lysates from OAC and matched normal esophageal and gastric samples from seven patients were subjected to LC MS/MS after tandem mass tag labeling and OFFGEL fractionation. Patient matched samples of OAC, normal esophagus, normal stomach, lymph node metastases and uninvolved lymph nodes were used from an additional 115 patients for verification of expression by immunohistochemistry (IHC).Over six thousand proteins were identified and quantified across samples. Quantitative reproducibility was excellent between technical replicates and a moderate correlation was seen across samples with the same histology. The quantitative accuracy was verified across the dynamic range for seven proteins by immunohistochemistry (IHC) on the originating tissues. Multiple novel tumor-specific candidates are proposed and EPCAM was verified by IHC.This shotgun proteomic study of OAC used a comparative quantitative approach to reveal proteins highly expressed in specific tissue types. Novel tumor-specific proteins are proposed and EPCAM was demonstrated to be specifically overexpressed in primary tumors and lymph node metastases compared with surrounding normal tissues. This candidate and others proposed in this study could be developed as tumor-specific targets for novel clinical staging and therapeutic approaches.

P-242 - Correlation between clinical profile and molecular biology in patients from eastern Algeria with colorectal cancer

Introduction: Cancer is increasingly a major public health problem in Algeria, where the number of cases and the proportions vary from one region to another (the East: 28%). Colorectal cancer is the third most common cancer in Algeria both sexes combined. Its incidence increases from 16.8 in 2011 to 19.4 per 100,000 inhabitants in 2012 in men (almost identical in women 18.3). Methods: Our work is based on a retrospective study to determine the biomolecular profile (RAS mutation, BRAF mutation and the TP53 mutation) of the 100 cases of colorectal cancer treated in 2016 at the level of 2 medical oncology services (the eastern Algerian: Constantine and Annaba) and correlate these results with the clinical profile of patients (sex, age, site and stage) Results: The Results showed that the RAS mutation is more frequent in patients less than 45 years (50%) versus 41% for patients over 45 years, this frequency is higher in women than in men (57.5% vs 39%). In right colic tumors, the RAS mutation was 60% vs 48% for left colonic tumors (including junction tumors) and 33% for rectal tumors. 51% of metastatic colorectal tumors were mutated versus 42% for tumors locally Advanced and 33% for localized forms. For the mutation of TP53: a higher frequency in cases less than 45 years (54%) and in men (41%) versus 33% (over 45 years) and 35% (women).48% of left colonic tumors Are TP53muted, 15% for the right colon and 38% for the rectum. In metastatic forms, the mutation was 44% vs 33% for locally advanced forms and 27% for localized forms. No BRAF mutations were found in 93% of patients (not sought for others) Conclusion: According to our results, RAS and TP53 mutations are more frequent in young patients, in metastatic forms, in women and in right colic tumors (for the RAS mutation) and in human and left colic tumors (for the Mutation TP53) whereas the BRAF mutation was not identified for the entire series of patients. The results obtained from this study provide information on the biomolecular profile of colorectal cancer treated in eastern Algeria and to correlate it with other prognostic factors and predictive therapeutic response.

Impact of chemoradiotherapy on PD1/PDL1 expression and clinical outcomes in gastroesophageal cancers.

4031 Background: Expression of the immune modulating proteins, programmed death receptor-1 (PD1) and its ligand (PDL1), in gastrointestinal malignancies is associated with poor prognosis. PD1/PDL1 expression levels have also been identified as predictors of response to checkpoint inhibition. Minimal data is available on how expression of PD1 and PDL1 is influenced by chemoradiotherapy (CRT). In this study, we investigated the relationship between PDL1/PD1 expression, CRT, and clinical outcomes in gastroesophageal (GE) cancer. Methods: With IRB approval, we identified 28 patients with gastric cardia or GE junction tumors who underwent neoadjuvant standard CRT followed by surgical resection. Pre-CRT biopsies and post-CRT surgical specimens were analyzed using quantitative immunohistochemistry for the expression of PDL1 and PD1. Samples were categorized as trace-low (TL) or moderate-high (MH) expressors of PDL1 and PD1. The impact of these and other clinical and pathologic variables on overall survival (OS) was assessed using multivariate cox proportional hazards modeling. Co-expression of PDL1 and PD1 in matched samples was determined by regression analysis. Results: Following CRT, PDL1 and PD1 expression increased in 54% and 32% of patients, respectively. On multivariate analysis, patients with MH expression of PD1 after CRT irrespective of pre-CRT expression levels had a significant decrease in OS compared to those with TL expression (median survival 23.1 vs 74.1 months; HR,3.31; CI,1.05-10.35; p = 0.039). In patients with gastric confined tumors, an increase in PD1 expression from TL to MH after CRT was associated with significantly lower OS rates (p = 0.003). Regression analysis of PD1 to PDL1 was significant (p &lt; 0.01) both before and after CRT, with a correlation coefficient of 0.34 in pre-CRT and 0.49 in post-CRT specimens. Conclusions: Elevated expression of PD1 is associated with poor OS in patients with GE cancer. Neoadjuvant CRT upregulates both PDL1 and PD1. In gastric cancer patients, this led to significantly worse survival. These data identify potential mechanisms of resistance and suggest a role for checkpoint inhibitors in combination with CRT.

PV-0322: Rapid Early Response of Gastroesophageal Junction Tumors During Real-time MRI-Guided Radiotherapy

PV-0322: Rapid Early Response of Gastroesophageal Junction Tumors During Real-time MRI-Guided Radiotherapy

Effects of Flaxseed Supplementation on Intestinal Tight Junction Protein and TNF‐alpha Gene Expression in Obese Mice

Increased gut permeability may lead to lipopolysaccharides translocation to the blood and causes endotoxemia and inflammation. The objective of this study was to determine the effect of the health promoting compounds of flaxseed on intestinal tight junction permeability by measuring intestinal tight junction protein (ZO‐1) and tumor necrosis factor (TNF)‐α expression. Sixty C57BL/6J male mice were randomly assigned into one of the following diet groups and fed for eight weeks: 1) 45% Kcal fat; 2) 45% Kcal fat, 10% whole flaxseed; 3) 45% Kcal fat, 6% defatted flaxseed; 4) 45% Kcal fat, 4% flaxseed oil; and 5) 16% Kcal fat. ZO‐1 and TNF‐α gene expression in mouse intestine samples were determined by real‐time quantitative PCR. The fold change in ZO‐1 and TNF‐α expression was calculated using 2−ΔΔCT method. TNF‐α expression was significantly decreased in whole flaxseed, defatted flaxseed, or flaxseed oil diet group compared to the high fat diet group (p&lt;0.05). ZO‐1 expression was significantly decreased in defatted flaxseed, flaxseed oil, or low fat diet group compared to the high fat diet group (p=0.0034). The results indicated that health promoting compounds of flaxseed down‐regulate ZO‐1 and TNF‐α expression. The specific mechanisms of down regulation of ZO‐1 and TNF‐α expression or gut permeability regulation by flaxseed and its health promoting compounds are unknown and need further study.Support or Funding InformationNDSU HDE College and HNES Department

Multimodality imaging spectrum of complications of horseshoe kidney.

Horseshoe kidney is the most common congenital renal fusion anomaly with an incidence of 1 in 400–600 individuals. The most common type is fusion at the lower poles seen in greater than 90% of the cases, with the rest depicting fusion at the upper poles, resulting in an inverted horseshoe kidney. Embryologically, there are two theories hypothesizing the genesis of horseshoe kidney – mechanical fusion theory and teratogenic event theory. As an entity, horseshoe kidney is an association of two anatomic anomalies, namely, ectopia and malrotation. It is also associated with other anomalies including vascular, calyceal, and ureteral anomalies. Horseshoe kidney is prone to a number of complications due to its abnormal position as well as due to associated vascular and ureteral anomalies. Complications associated with horseshoe kidney include pelviureteric junction obstruction, renal stones, infection, tumors, and trauma. It can also be associated with abnormalities of cardiovascular, central nervous, musculoskeletal and genitourinary systems, as well as chromosomal abnormalities. Conventional imaging modalities (plain films, intravenous urogram) as well as advanced cross-sectional imaging modalities (ultrasound, computed tomography, and magnetic resonance imaging) play an important role in the evaluation of horseshoe kidney. This article briefly describes the embryology and anatomy of the horseshoe kidney, enumerates appropriate imaging modalities used for its evaluation, and reviews cross-sectional imaging features of associated complications.

Su1232 - Bridging the Gap after Esophago Gastrectomy for Locally Advanced Type2 Ge Junction Tumors with Esophago Gastrostomy or Esophago Jejunostomy and Analysis of Outcome

Su1232 - Bridging the Gap after Esophago Gastrectomy for Locally Advanced Type2 Ge Junction Tumors with Esophago Gastrostomy or Esophago Jejunostomy and Analysis of Outcome

New evidence guiding extent of lymphadenectomy for esophagogastric junction tumor: Application of Ber-Ep4 Joint with CD44v6 staining on the detection of lower mediastinal lymph node micrometastasis and survival analysis.

For Siewert type II adenocarcinoma of the esophagogastric junction (AEJ), the optimal surgical approach and extent of lymph nodes dissection remain controversial. Immunohistochemistry (IHC) has been reported to be available for identifying lymph node micrometastasis (LNMM) in patients with AEJ. This was a prospective case series of patients who underwent R0 resection and lower mediastinal lymphadenectomy from January 2010 to June 2015 in Fujian Medical University Union Hospital for Siewert type II AEJ. The outcomes were analyzed retrospectively. A total of 1325 lymph nodes were collected from 49 patients, grouped into 3 groups: lower mediastinal, paracardial, and abdominal. The former 2 groups were examined by monoclonal antibodies against Ber-Ep4 and CD44v6. The incidence of LNMM in mediastinal group was 37% (18/49) for Ber-Ep4 and 33% (16/49) for CD44v6. While in routine histological diagnosis, the number of patients with the positive lymph nodes was 7 (14%). When combining IHC with histopathology (HE) staining, the incidence of positive mediastinal lymph nodes was increased to 24%, with a total number of 37 lymph nodes from 28 patients (57%). Micrometastases indicated by Ber-Ep4 and CD44v6 were associated with the depth of tumor invasion (P = 0.020 and 0.037, respectively), histopathological nodal status (P = 0.024 and 0.01, respectively), and Lauren classification (P = 0.038 and, respectively). Expression of CD44v6 and Ber-Ep4 was positively correlated (r = 0.643, P < 0.001). The 3- and 5-year survival rates for all patients were 66% and 50%, respectively. The patients with LNMM had a lower 3-year survival rate of 51%, compared to 80% from no LNMM group; 5-year survival rate was also lower in LNMM group, which is 29% versus 68% (P = 0.006) in the no LNMM group. Patients with positive Ber-Ep4 cells had a lower survival, but not statistically significant (P = 0.058). CD44v6-positive group had a significantly reduced survival (P < 0.001). In patients group with negative lower mediastinal lymph nodes, patients without LNMM obtained a significant survival benefit (P = 0.021). Our study demonstrated that routine test for LNMM is necessary for patients with negative lymph nodes. As a positive prognostic factor, thorough lower mediastinal lymphadenectomy in an invasive approach should be considered when necessary. Ber-Ep4 and CD44v6 were shown to be great markers for detecting LNMM.

The clinicopathologic characteristics and prognostic factors of gastroesophageal junction tumors according to Siewert classification.

The treatment of gastroesophageal junction tumors remains controversial due to confusion on whether they should be considered as primary esophageal or as gastric tumors. The incidence of these tumors with poor prognosis has increased, thus creating scientific interest on gastroesophageal cancers. Esophagogastric cancers are classified according to their location by Siewert, and the treatment of each type varies. We evaluated the prognostic factors and differences in clinicopathologic factors of patients with gastroesophageal junction tumor, who have been treated and followed-up in our clinics. We retrospectively analyzed 187 patients with gastroesophageal junction tumors who have been operated and treated in the Oncology Department between 2005 and 2014. The chi-square test was used to evaluate differences in clinicopathologic factors among Siewert groups I, II and III. Prognostic factors were analyzed by univariate and multivariate analysis. The median age of our patients was 62 years, and approximately 70% was male. Nineteen patients (10.2%) had Siewert I tumors, 40 (21.4%) II, and the remaining 128 (64.4%) had Siewert III tumors. Siewert III tumors were at more advanced pathologic and T stages. Preoperative chemoradiotherapy was mostly applied to Siewert group I patients. There was no difference between the 3 groups in terms of recurrence. While the median overall survival and 2-year overall survival rate were 26.6 months and 39.6%, the median disease free survival and disease free survival rates were 16.5 months and 30.1%, respectively. The N stage, pathologic stage, vascular invasion, lymphatic invasion, perineural invasion, surgical margin, and grade were associated with both overall survival and disease free survival, while pathologic stage and presence of recurrence were significant factors for overall survival. The median disease free survival for Siewert III tumors was 20 months, 11.3 month for Siewert I tumors, and 14 months for Siewert II tumors, but the finding was not statistically significant (p=0.08). Although gastroesophageal junction tumors were grouped according to their location and they exerted different clinicopathologic properties, their prognosis was similar.