Gastroesophageal tube of the Iguana iguana (Iguanidae): histological description, histochemical and immunohistochemical analysis of 5-HT and SS cells

The work aims were to describe the histological and histochemical structure of the gastroesophageal tube of Iguana iguana and verify the occurrence and distribution of immunoreactive serotonin (5-HT) and somatostatin (SS) cells. Fragments of the gastrointestinal tract (GIT) of five iguanas were which underwent standard histological and immunohistochemistry technique. Immunoreactive cells for 5-HT and SS were quantified using the STEPanizer. The oesophagus has ciliated columnar pseudostratified epithelium with staining Alcian blue (AB) + and goblet cells highly reactive to periodic acid Schiff (PAS). In the cervical oesophagus, the numerical density of 5-HT cells per unit area (QA [5-HT cells]/µm2) was 4.6x10-2 ± 2.0 and celomatic oesophagus presented QA = 4.0x10-2 ± 1.0. The epithelium of the stomach is simple columnar, PAS and AB +. The cranial and middle regions of the stomach presented (QA [5-HT cells]/µm2) = 6.18x10-2 ± 3.2 and the caudal region, QA = 0.6x10-2 ± 0.2. The SS cells were only observed in the caudal stomach, with numerical density (QA [SS cells]/µm2) = 1.4x10-2 ± 0.9 In I. iguana, variation was observed in terms of the distribution of mucus secretions and the pattern of occurrence of serotonin and somatostatin-secreting enteroendocrine cells in the TGI, which possibly will result in an interspecific adaptive response.

P-EGS19 Complete oesophageal transection during thyroidectomy; Successful management of anastomotic leak using endoluminal vacuum therapy (EVT) following failed primary repair

Background Perforation of the cervical oesophagus is an extremely rare but recognised complication of thyroidectomy. As with all oesophageal perforations management depends on timing of diagnosis in relation to the timing of injury, the size of the oesophageal wall defect, extent of extraluminal contamination, and how unwell the patient is with respect to sepsis. We report a case of complete transection of the cervical oesophagus during total thyroidectomy and its subsequent management. Methods A previously well 32-year-old female had a complete cervical oesophageal transection during total thyroidectomy and neck dissection for papillary carcinoma of thyroid. This was recognised by her ENT surgeon who repaired the oesophagus primarily. Subsequently, she developed sepsis with cellulitis of her anterior chest wall. Cross-sectional imaging demonstrated a leak at the site of the cervical oesophageal repair. Gastroscopy confirmed a 50% dehiscence of the oesophageal anastomosis. Control and management of her oesophageal leak was achieved with EVT delivered using an ad-hoc endoluminal vacuum device (EVD) constructed from open cell foam sutured around the distal end of a nasogastric tube. Results The patient was managed in the intensive care unit (ICU) with appropriate organ support and antimicrobial cover. A surgical jejunostomy was placed to facilitate enteral feeding. EVT was delivered using the ad-hoc EVD which was placed endoscopically and situated intraluminally across the anastomotic leak site. Continuous negative pressure (125 mmHg) was applied. Six EVD changes were required to heal the leak. Her total length of stay was 41 days, of which 38 days were in ICU. There were no periprocedural complications related to using the EVD or EVT, although the patient subsequently developed an oesophageal stricture which required endoscopic dilatation. Conclusions Accidental complete transection of the cervical oesophagus is extremely rare. This case highlights the importance of a multidisciplinary team approach for managing such cases. EVT is an emerging treatment option for upper gastrointestinal (UGI) leaks and is reported to be safe and effective for leaks from a wide range of causes throughout the UGI tract. Successful resolution of the oesophageal leak in this unusual case demonstrates the utility of EVT in difficult clinical situations which may otherwise pose a formidable management challenge using traditional treatment strategies.

Heterotopic Gastric Mucosa in Cervical Oesophagus: Clinical Observations

Aim. Description of the endoscopic and clinical traits of heterotopic gastric mucosa (HGM) observed in cervical oesophagus.Key points. HGM in proximal oesophagus can be asymptomatic or have various clinical manifestations. A 40-yo female patient consulted a gastroenterologist with complaints of cough and globus sensation. For several years she was visiting an otorhinolaryngologist and psychotherapist, with therapy ineffective. Esophagogastroduodenoscopy (EGDS) at the last visit revealed several foci of HGM in cervical oesophagus of 1.2 x 0.8 cm maximal size. The patient was prescribed a combined prokinetic — proton pump inhibitor therapy, which relieved the symptoms. EGDS in a 21-yo patient without active complaints revealed a 2 cm-wide HGM of 4/5 cervical oesophageal lining with acidproducing zones.Conclusion. Two different scenarios of cervical oesophageal HGM are described, the first one manifested with laryngopharyngeal reflux, and the second devoid of clinical manifestations despite a large heterotopic site.

Rare Case of Intestinal-Type Adenocarcinoma Arising in Cervical Oesophageal Heterotopic Gastric Mucosa

Heterotopic Gastric Mucosa (HGM) also termed gastric inlet patch or inlet patch, is a rare and benign phenomenon in cervical oesophagus and can be missed during endoscopy. It has an average incidence of 2.5%. Adenocarcinoma arising in the background of gastric heterotopia is very rare and uncommon in the upper oesophagus. A 46-year-old male presented with hoarseness and progressive dysphagia for solids for the past one month. Upper Gastrointestinal Endoscopy (UGIE) revealed a tight stricture at 19-20 cm from the incisors. Initial mucosal biopsies were not conclusive. With high clinical suspicion of malignancy, patient underwent bougie dilation of oesophageal stricture followed by repeat biopsy. Histology revealed an intestinal type of adenocarcinoma, arising in a background of gastric heterotopia of the cervical oesophagus. Alcian Blue/Periodic Acid Schiff (AB/PAS) staining was positive in both the heterotopic glands and in the cancer, indicating the presence of intestinal metaplasia. Tumour cells were immunopositive for cytokeratin-7. A Positron Emission Tomography – Computed Tomography scan revealed a metabolically active lesion located in the upper third of the oesophagus along with uptake in right supraclavicular node. This case report describes a patient with primary intestinal type adenocarcinoma of the cervical oesophagus in the background of HGM not related to Barrett’s oesophagus.

A Case Report on the Child with Two Coins Ingested Foreign Bodies in the Esophagus During the Lockdown in COVID 19 Pandemic

A 4-year-old child presented to the emergency department with an acute onset of dysphagia and vomiting. A plain X-ray soft tissue neck lateral view revealed a double circular opacity in the cervical oesophagus consistent with an ingestion of multiple foreign bodies. Preoperative planning and SARS-CoV2 testing is of particular importance for the pediatric population and if testing cannot be performed, patients in all age groups should be handled as though they are positive for COVID-19, and appropriate precautions should be taken. The child was taken to the theatre for rigid pharyngo-oesophagoscopy and removal of the coins. After the first coin was removed subsequent endoscopic examination revealed a second coin at the same location. This extremely rare case of two ingested coins becoming impacted with perfect radiological alignment, we would therefore advocate having a low threshold for performing a ‘second look’ endoscopy after removal of the first foreign body with postoperative X-rays.

Two concurrent embryonal rhabdomyosarcomas of the oesophageal and perilaryngeal tissue in an adult dog: imaging, cytological and histological features

A five-year-old neutered male Labrador Retriever was presented for recurring severe dyspnoeic episodes. Oral examination performed under sedation revealed a mass originating from the left arytenoid. CT highlighted a large perilaryngeal soft-tissue mass abutting the oesophagus, with a small intralaryngeal component. The mass created a narrowing of the laryngeal lumen and displaced the cranial cervical oesophagus dorsally and to the right. CT also highlighted a second smaller mass rostrally at the level of an oesophageal outpouching, narrowing the caudal aspect of the nasopharynx. The perilaryngeal mass was aspirated under ultrasound guidance. Cytology was suggestive of a tumour arising from skeletal muscle and a rhabdomyosarcoma was suspected. Due to poor prognosis, the patient was euthanased. Postmortem examination confirmed two masses affecting the cranial cervical oesophagus, one of which also invaded the perilaryngeal tissue. Histology and immunohistochemistry provided a final diagnosis of two concurrent oesophageal and perilaryngeal embryonal rhabdomyosarcomas.

Adenosquamous carcinoma of the cervical oesophagus in a dog

ABSTRACT: A 9-year-old male Shih Tzu dog presented with a mass on the ventral region of the neck and developed ptyalism. Radiographs revealed a radiodense nodule located in the mid-third of the oesophagus compressing the trachea. Preoperative cytology showed large neoplastic cells with abundant vacuolated cytoplasm arranged in clusters. The nodule was removed by oesophagectomy and submitted for histopathology. Microscopically, the oesophageal mass was multilobulated and unencapsulated. It had a mixed cellular growth pattern with areas showing squamous and glandular differentiation. The squamous component of the tumor was formed by solid strands of neoplastic epithelial cells; many neoplastic cells had undergone central keratinization and sometimes formed keratin pearls. The deeper adenocarcinomatous portion of the tumor consisted of tubules filled with slightly basophilic mucinous material. Histological and immunohistochemical examination confirmed the diagnosis of primary adenosquamous carcinoma (ASC) of the esophagus. This is the first report of primary ASC of the cervical oesophagus in a dog.

P157 GIANT PEDUNCULATED OESOPHAGEAL LIPOSARCOMAS: A CASE AND REVIEW OF RESECTION TECHNIQUES

Aim Liposarcomas are rare causes of oesophageal tumours, accounting for <1% of tumours. We present a case of giant oesophageal liposarcoma with a discussion focusing on resection techniques. Background & Methods A 54-year-old gentleman presented to the hospital with symptoms of anaemia and weight loss for 3 months. A CT scan and oesophagogastroduodenoscopy (OGD) showed a giant, pedunculated polyp extending from the cervical oesophagus to cardioesophageal junction (CEJ) with mucosal ulceration at its distal aspect. Endoscopic ultrasound (EUS) revealed a 24 x 6 cm submucosal pedunculated mass with lipomatous regions and core biopsy only showed rare groups of spindle cells with no malignancy. Resection was advised in view of occult bleeding from polyp and endoscopic resection was deemed unsuitable in view of a highly vascular stalk and large size of polyp. He underwent surgical resection via a left cervical oesophagostomy with gastrostomy for polyp retrieval. Final histology showed a dedifferentiated liposarcoma arising within a giant fibrovascular polyp. Results Open surgery has classically been standard of treatment, but endoscopic resection is less morbid and invasive. Endoscopic techniques described include using a retraction suture followed by division of the polyp stalk using ultrasonic shears, using a snare, endoscopic submucosal dissection (ESD), and application of hemoclips following diathermy. In cases where endoscopic resection is not feasible, surgery such as oesophagostomy, oesophagectomy and laparotomy for resection and retrieval of the tumour have been described. Main reason for oesophagectomy was the presence of a submucosal (rather than polypoid, pedunculated) large tumour. For resection via oesophagostomy, stalk transection can be performed via stapling devices or suture ligation. Conclusion Giant oesophageal liposarcomas are very rare tumours. Such tumours are usually polypoid, arising from a pedicle in the proximal oesophagus. Resection techniques have shifted from oesophagectomy to less invasive means such as endoscopic resection or oesophagostomy. Decision on type of resection technique depends on tumour characteristics and location; with the guiding principle being resection with clear margins in order to prevent local recurrence.