Extent of Microscopic Spread and Lymph Node Metastasis in Patients with Esophageal and Gastroesophageal Junction Carcinoma Treated by Surgical Resection Only

Gastroesophageal junction (GEJ) cancer is a tumor that occurs at the junction of stomach and esophagus anatomically. GEJ cancer frequently metastasizes to lymph nodes, however the heterogeneity and clonal evolution process are unclear. This study is the first of this kind to use single cell DNA sequencing to determine genomic variations and clonal evolution related to lymph node metastasis. Multiple Annealing and Looping Based Amplification Cycles (MALBAC) and bulk exome sequencing were performed to detect single cell copy number variations (CNVs) and single nucleotide variations (SNVs) respectively. Four GEJ cancer patients were enrolled with two (Pt.3, Pt.4) having metastatic lymph nodes. The most common mutation we found happened in the TTN gene, which was reported to be related with the tumor mutation burden in cancers. Significant intra-patient heterogeneity in SNVs and CNVs were found. We identified the SNV subclonal architecture in each tumor. To study the heterogeneity of CNVs, the single cells were sequenced. The number of subclones in the primary tumor was larger than that in lymph nodes, indicating the heterogeneity of primary site was higher. We observed two patterns of multi-station lymph node metastasis: one was skip metastasis and the other was to follow the lymphatic drainage. Taken together, our single cell genomic analysis has revealed the heterogeneity and clonal evolution in GEJ cancer.

Download Full-text

PS02.192: TWO CASES OF PRIMARY MALIGNANT MELANOMA OF ESOPHAGUS TREATED WITH SUBTOTAL ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.192 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 176-176

Author(s):

Ryosuke Hirohata ◽

Manabu Emi ◽

Yoichi Hamai ◽

Yuta Ibuki ◽

Morihito Okada

Keyword(s):

Lymph Node ◽

Survival Rate ◽

Malignant Melanoma ◽

Lymph Node Metastasis ◽

Surgical Resection ◽

Primary Malignant Melanoma ◽

Lower Esophagus ◽

Subtotal Esophagectomy ◽

Node Metastasis ◽

Upper Gastrointestinal

Abstract Background Malignant melanoma of the primary esophagus is rare, in general it has high malignancy and poor prognosis. We report two cases of early-stage primary malignant melanoma of esophagus (PMME) underwent subtotal esophagectomy. Methods Case presentation Results [Case 1]A 66-year-old man was pointed out a black legion on the lower esophagus by upper gastrointestinal endoscope for screening purposes. The lesion was diagnosed as malignant melanoma by biopsy. In addition, another black lesion was also found in the pharynx, but there was no malignant cell. Other examinations did not reveal any findings of lymph node metastasis and distant metastasis. We diagnosed PMME (T1aN0M0 Stage 0) and performed surgical resection. Pathologically it was pT1a (LPM), pN0. There is no recurrence, and it is under observation. [Case 2] A 51-year-old woman was conducted upper gastrointestinal endoscopy for the purpose of scarring epigastric pain, and a black lesion was pointed out in lower esophagus. Surgical resection was performed with diagnosis of PMME (T1bN0M0 Stage I). The pathological stage was pT1a (MM), pN0. Conclusion The 5 year survival rate of malignant melanoma of primary esophagus is poor with about 30 to 35%, and especially in cases with lymph node metastasis, the survival rate further decreases. The both cases were discovered accidentally by endoscopic examination, leading to early diagnosis and early treatment. Therefore, long survival is expected. There is also a report that melanosis is associated with melanoma, so case 1 requires careful follow-up observation. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Clinical Pathological Analysis of Surgically Resected Superficial Esophageal Carcinoma to Determine Criteria for Deciding on Treatment Strategy

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.3.211 ◽

1997 ◽

Vol 3 (4) ◽

pp. 211-220 ◽

Cited By ~ 16

Author(s):

H. Makuuchi ◽

H. Shimada ◽

K. Mizutani ◽

O. Chino ◽

T. Nishi ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Surgical Resection ◽

Lymph Vessel ◽

Depth Of Invasion ◽

Submucosal Cancer ◽

Node Metastasis ◽

Wide Range ◽

Esophageal Carcinomas ◽

Radical Surgical Resection

We performed a clinical pathological study of conventionally resected superficial esophageal carcinomas since this type of lesion has been increasing, in order to develop criteria of determination for therapeutic strategies. Pathological studies were performed on specimens obtained by radical surgical resection in 133 cases of superficial esophageal cancer. Evaluation was performed in terms of the gross classification of the lesion type, depth of invasion, lymph node metastasis, vascular invasion, size of the lesion, outcome, etc. In 0-I, 0-IIc+0-IIa, and 0-III type submucosal cancer lesions the rate of metastasis to lymph nodes was more than 40%, but in 0-IIa and 0-IIb mucosal cancer cases no lymph node metastasis was observed. 0-IIc type lesions showed a wide range of invasiveness, ranging from m1 to sm3. In cases with m1 or m2 invasion, no lymph node or lymph-vessel invasion was recognized, but in m3, sm1, sm2, and sm3 cases lymph node metastasis was recognized in 12.5%, 22.2%, 44.0% and 47.4%, respectively. In 47% of lesions with a greatest dimension of less than 30 mm invasion was limited to the mucosa. Seventy-two percent of m1 and m2 cases were 30 mm in size or less. Lymph node metastasis was recognized in only 16.7% of cases less than 30 mm in size, but in cases of lesions 30 mm or more the rate of lymph node metastasis was 35.8%. 0-IIb and 0-IIa type lesions are indications for endoscopic esophageal mucosal resection (EEMR), while 0-I, 0-IIc+0-IIa, and 0-III lesions should be candidates for radical surgical resection. In the 0-IIc category, lesions in which the depression is relatively flat and with a finely granular surface are indications for EEMR, but those cases in which the surface of depression shows granules of varying sizes should be treated with radical surgical resection. Cases of 0-IIa type 30 mm or larger in greatest dimension which have a gently sloping protruding margin shoulder or reddening should be treated with caution, but EEMR can be performed first and subsequent therapeutic strategy decided on, based on the pathological findings of the specimen.

Download Full-text

Tu1518 Distant Lymph Node Metastasis in Gastroesophageal Junction Adenocarcinoma: Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) Impact

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2012.03.1164 ◽

2012 ◽

Vol 75 (4) ◽

pp. AB432

Author(s):

Marc Giovannini ◽

Erwan Bories ◽

Fabrice Caillol ◽

Christian Pesenti ◽

Genevieve M. Monges ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Fine Needle Aspiration ◽

Gastroesophageal Junction ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Fine Needle ◽

Node Metastasis ◽

Gastroesophageal Junction Adenocarcinoma ◽

Distant Lymph Node Metastasis

Download Full-text

Surgical Resection for Lymph Node Metastasis After Liver Transplantation for Hepatocellular Carcinoma

Anticancer Research ◽

10.21873/anticanres.11395 ◽

2017 ◽

Vol 37 (2) ◽

pp. 891-896 ◽

Cited By ~ 2

Author(s):

TORU IKEGAMI ◽

TOMOHARU YOSHIZUMI ◽

JYUNJI KAWASAKI ◽

AKIHISA NAGATSU ◽

HIDEAKI UCHIYAMA ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Surgical Resection ◽

Node Metastasis

Download Full-text

Rapid metastasis of stage IA primary pulmonary high-grade mucoepidermoid carcinoma with a cystic airspace: a case report and reflection

Journal of International Medical Research ◽

10.1177/03000605211038137 ◽

2021 ◽

Vol 49 (9) ◽

pp. 030006052110381

Author(s):

Yi Chen ◽

Fangbiao Zhang ◽

Xiaomei Chen ◽

Liping Yan ◽

Xiangyan Zhang ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Surgical Resection ◽

Mucoepidermoid Carcinoma ◽

Histopathological Examination ◽

Left Lung ◽

High Grade ◽

Early Metastasis ◽

Node Metastasis ◽

Stage Ia

Primary pulmonary high-grade mucoepidermoid carcinoma (MEC) with a cystic airspace is uncommon, and early metastasis is extremely rare. In such cases, however, it is clinically important for clinicians to consider whether the tumor has spread to the lymph nodes through the cystic airspace. A 77-year-old man presented to our hospital with cough and hemoptysis. Chest computed tomography showed a 25-mm-diameter mass with a cystic airspace located in the upper lobe of the left lung. The possibility of malignancy was considered. Without a definitive preoperative diagnosis, left upper lobectomy and mediastinal lymphadenectomy were performed. Histopathological examination revealed the typical histological characteristics of high-grade MEC (stage IA) and no lymph node metastasis. However, lymph node metastasis was found 6 months after surgical resection, and radiochemotherapy was performed. The patient developed widespread metastatic disease 4 months following completion of radiochemotherapy and died 2 months later. Primary pulmonary MEC with a cystic airspace is a rare malignant disease with uncommon imaging findings. Complete surgical resection is the main treatment method for high-grade MEC. In this case, we hypothesize that early metastasis was caused by seeding of tumor cells through the cystic airspace.

Download Full-text