Prevalence of Helicobacter pylori infection among patients with esophageal carcinoma

BACKGROUND Helicobacter pylori(H.pylori)is a widespread microorganism related to gastric adenocarcinoma(AC).In contrast,it has been reported that an inverse association exists between H.pylori infection and esophageal carcinoma.The mechanisms underlying this supposedly protective effect remain controversial.AIM To determine the prevalence of H.pylori infection in esophageal carcinoma patients,we performed a retrospective observational study of esophageal tumors diagnosed in our hospital.METHODS We retrospectively reviewed the prevalence of H.pylori infection in a cohort of patients diagnosed with esophageal carcinoma.Concomitant or previous proton pump inhibitor(PPI)usage was also recorded.RESULTS A total of 89 patients with esophageal carcinoma(69 males,77.5%),with a mean age of 66 years(range,26-93 years)were included.AC was the most frequent pathological variant(n=47,52.8%),followed by squamous cell carcinoma(n=37,41.6%).Fourteen ACs(29.8%)originated in the gastroesophageal junction and 33(70.2%)in the esophageal body.Overall,54 patients(60.7%)presented at stages III and IV.Previous H.pylori infection occurred only in 4 patients(4.5%),3 with AC(6.3%of all ACs)and 1 with squamous cell carcinoma(2.7%of all squamous cell tumors).All patients with previous H.pylori infection had stage III-IV.Only one patient had received prior H.pylori eradication therapy,whereas 86(96.6%)had received previous or concomitant PPI treatment.CONCLUSION In our cohort of patients,and after histologic evaluation of paraffin-embedded primary tumors,we found a very low prevalence of previous H.pylori infection.We also reviewed the medical history of the patients,concluding that the majority had received or were on PPI treatment.The minimal prevalence of H.pylori infection found in this cohort of patients with esophageal carcinoma suggests a protective role.

The Effect of Chinese Tea on Occurrence of Esophageal Tumor Induced by N-Nitrosomethylbenzylamine in Rats

Five groups of rats (40 rats per group) were given five different varieties of Chinese tea (1 g/50 ml) and another two groups of rats (a positive control and a negative control) were given tap water as drinking water. Except for the negative control group, all the animals were intubated with A'-nitrosomethyibenzylamine (NMBzA, 5 mg/kg body wt/week). Half of the animals in each group were sacrificed after 6 weeks and the remaining animals at the end of 12 weeks. The incidences of esophageal mucosa lesions (16-59%) at the end of6 weeks were significantly lower in the tea-treated rats than in the positive control group (100%). The incidences of esophageal tumor at the end of 12 weeks (42-67%) were also significantly lower in the tea-treated groups than in the positive control group (90%). The same phenomenon was found with respect to the size and number of tumors in each tumor-bearing animal. The relative anticarcinogenic effects of the five varieties of Chinese tea were different. The Fujian oolong tea and jasmine tea exhibited the strongest effects. The results suggest that Chinese tea can effectively inhibit the carcinogenesis Caused by an N-nitroso compound. 1990 Academic Press.Inc.

Esophageal granular cell tumor:A case report

BACKGROUND Esophageal granular cell tumor(eGCT)is a relatively rare,usually benign neoplasm of the neuroectoderm.It is derived from Schwann cells.Clinical symptoms of this disease are non-specific.However,the most common presenting symptom is dysphagia,which is mostly misdiagnosed as esophageal polyps under gastroscopy,yet it has a 2%chance of forming cancers.We report the case of a 52-year-old woman with solitary eGCT,then analysed retrospectivelyanalyze the clinical features and elucidate on the reduction of misdiagnosis and missed diagnosis.CASE SUMMARY A 52-year-old woman was diagnosed with“esophageal granulossoma”after esophagoscopy,which was mistaken for eGCT.CONCLUSION eGCT diagnosis depends on characteristic pathomorphologies and detection of the S-100 protein.Endoscopic mucosal resection is the preferred therapeutic method.

Metachronous primary esophageal squamous cell carcinoma and duodenal adenocarcinoma:A case report and review of literature

BACKGROUND The prevalence of multiple primary malignant neoplasms(MPMNs)is increasing in parallel with the incidence of malignancies,the continual improvement of diagnostic models,and the extended life of patients with tumors,especially those of the digestive system.However,the co-existence of MPMNs and duodenal adenocarcinoma(DA)is rarely reported.In addition,there is a lack of compre-hensive analysis of MPMNs regarding multi-omics and the tumor microenvir-onment(TME).CASE SUMMARY In this article,we report the case of a 56-year-old man who presented with a complaint of chest discomfort and abdominal distension.The patient was diagnosed with metachronous esophageal squamous cell carcinoma and DA in the Department of Oncology.He underwent radical resection and chemotherapy for the esophageal tumor,as well as chemotherapy combined with a programmed death-1 inhibitor for the duodenal tumor.The overall survival was 16.6 mo.Extensive evaluation of the multi-omics and microenvironment features of primary and metastatic tumors was conducted to:(1)Identify the reasons responsible for the poor prognosis and treatment resistance in this case;and(2)Offer novel diagnostic and therapeutic approaches for MPMNs.This case demonstrated that the development of a second malignancy may be independent of the location of the first tumor.Thus,tumor recurrence(including metastases)should be distinguished from the second primary for an accurate diagnosis of MPMNs.CONCLUSION Multi-omics characteristics and the TME may facilitate treatment selection,improve efficacy,and assist in the prediction of prognosis.Core Tip:Multiple primary malignant neoplasms(MPMNs)are increasingly prevalent in clinical practice,most frequently in the digestive system.We report a rare case of MPMN with a combination of esophageal squamous cell carcinoma and duodenal adenocarcinoma.According to PubMed-indexed literature,there are no standard guidelines or expert consensus on the etiology and comprehensive treatment.We also conducted a detailed study of the features of primary and metastatic tumors.The aim of this report was to identify the reasons responsible for the poor prognosis and treatment resistance in this case through histological data and provide new diagnostic and treatment directions for MPMNs.INTRODUCTION Multiple primary malignant neoplasms(MPMNs),also termed multiple primary cancers,refer to two or more primary tumors that occur simultaneously or sequentially in a single or multiple organs[1].According to the time interval from the diagnosis of the first tumor,MPMNs are divided into synchronous cancer(SC)(<6 mo)and metachronous cancer(MC)(≥6 mo)[2].The detection rate of the second or multiple primary tumors is also on the rise due to newer diagnostic methods and treatments,as well as the longer survival times of patients with cancer.MPMNs are most commonly reported in the digestive system;however,their occurrence in combination with duodenal adenocarcinoma(DA)is extremely rare.In this article,we describe the case of a patient who had metachronous esophageal squamous cell carcinoma(ESCC)and DA with multiple metastases.In this analysis,we thoroughly examined the multi-omics features and tumor-related immune microenvironment.OUTCOME AND FOLLOW-UP The patient was eventually followed up until clinical death on June 18,2022(Figure 2),with an overall survival 16.6 mo.

EXPRESSION OF mdr-1 GENE IN CANCER TISSUE AND ITS ASSOCIATION WITH MORPHOLOGICAL INDEXES OF ESOPHAGEAL CARCINOMA IN ANYANG

Objective: Overexpression of mdr-1 gene is associated with multidrug resistance (MDR) and aggressive characteristics of malignance. Our purposewas to detect the levels of P-gp expression in fresh untreated esophageal carcinomas, and to correlate these levels to current prognostic indicators of morphology.Methods: Reverse transcription polymerase chain reaction (RT-PCR) was used to investigate mdr-1 gene expression of 46 samples from untreated esophageal carcinoma, and compared the positive incidences among differentiated grades, TNM stages and macroscopic types.Results: All 46 samples were pathologically squamous cell carcinoma. The positive' incidences of mdr-1 gene expression were 37% (17/46) in whole group,35% (6/17), 40% (8/20), 33% (3/9), for Ⅰ,Ⅱ and Ⅲdifferentiated grades, respectively. The expression rates of 33% (6/18), 40% (5/12), and 37% (6/16), were found in Ⅱa, Ⅱ, and Ⅲ stage of TNM, respectively. In macroscopic type view, the positive incidence was 37%(3/8) in constrictive, 33% (5/15) in fungating, 40% (6/14)in marrowlike, 33% (319) in ulcerative type. There were no statistically significant differences among each category system of morphology.Conclusion: The result, high level expression of mdr-1 gene in untreated esophageal carcinoma, suggested the poor efficacy of chemotherapy for some esophageal carcinoma patients. And we should cautiously choose cases who will receive chemotherapy. Surgery is still the best treatment for carcinoma of esophagus. Besides, the data also revealed that the expression of mdr-1 gene in untreated esophageal cancer was independent of morphologic prognostic indexes, and that there were no correlation between mdr-1 gene expression and morphological indexes.

Esophagogastric junctional neuroendocrine tumor with adenocarcinoma:A case report

BACKGROUND At present,cases of esophageal neuroendocrine tumors combined with cardia adenocarcinoma are extremely rare worldwide,and there are no clinical reports.Herein,we describe such a case for clinical reference.CASE SUMMARY The presence of cardia cancer and esophageal neuroendocrine tumors in a single patient has not yet been reported.The patient in this case underwent prompt endoscopic treatment and additional surgical resection.Pathology revealed the following:The distance between the cardia cancer and the esophageal neuroendocrine tumors was small,approximately 3 mm.Vascular invasion was observed.The esophageal neuroendocrine tumor was determined to be grade G3.According to the treatment guidelines,after the patient received an explanation of their condition,additional surgical procedures were provided in a timely manner.Early detection and early treatment can successfully prolong survival and improve the quality of life of patients.CONCLUSION Early detection and early treatment can successfully prolong survival and improve the quality of life of such patients.

MRI FEATURES AND RESECTABILITY PREDITION OF ESOPHAGEAL CARCINOMA

To evaluate MRI in esophageal carcinoma and its resectability. MR imaging (sagittal, coronal, axial) were performed in 30 cases (male 24 cases, female 6 cases, average age 58 years) and retrospectively analyzed. Results showed that MRI clearly demonstrated the location, actual length, and extent of esophageal carcinoma as well as its relation with surrounding structures in all cases. Metastasis to other organs was found in 7 cases. The conclusion indicated that MR imaging played an important role in preoperative diagnosis of esophageal carcinoma, providing valuable information in determining resectability of the tumor.

Hybrid laparo-endoscopic access:New approach to surgical treatment for giant fibrovascular polyp of esophagus:A case report and review of literature

BACKGROUND Fibrovascular polyps are rare type of esophageal submucosal neoplasms.They are highly vascularized and can cause difficulty swallowing and even fatal complications such as uncontrolled bleeding and death caused by asphyxiation in case of tumor migration to oropharynx.In the article we describe a novel hybrid technique to surgical treatment–an endoscopic submucosal dissection with laparoscopic removal of the tumor.CASE SUMMARY The patient with a giant fibrovascular esophageal polyp presented with cough,discomfort in the throat,difficulty swallowing,and an episode of tumor migration into oropharynx.The patient was investigated with several imaging studies and was diagnosed with a giant highly vascularized esophageal fibrovascular polyp.The follow-up period of eight months accompanied with no complications.CONCLUSION This method has been shown to have comparable rates of recurrence and a low risk of complications.

STUDIES ON NUTRITION AND PRECANCEROUS LESIONS OF THE ESOPHAGUS IN THE ADOLESCENTS

This paper reports the prevalence of chronic esophagitis and nutritional status among 538 young persons aged 15 to 26 years from the high risk area for esophageal cancer. Of these subjects, 166 were from households with history of esophageal cancer and 372 were from households without history of esophageal cancer. The Incidences of chronic esophagltis among male and female adolescents were 37. 6% and 36% respectively, which was significantly higher than those in the low risk area (17%). The frequency of chronic esophagltis in the adolescents in the households with history of esophageal cancer was aiso higher than in those In the households without history of esophageal cancer. The deficiencies of vitamins, especially of riboflavin and ascorbate, are prevalent and severe among these adolescents. Ascorbate deficiency Is correlated with the severity of the chronic esophagltis. These results indicate that chronic esophagltis may be involved in the natural history of esophageal carclnogenesis. Nutrient deficiencies may create an environment favorable to the development of precancerous lesions.

Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography–fine needle aspiration:A case report

BACKGROUND Benign esophageal tumors are rare accounting for<1%of esophageal tumors;two-thirds of which are leiomyomas.Esophageal leiomyoma is a benign tumor derived from mesenchymal tissue that is completely muscularly differentiated.Most esophageal leiomyomas are<5 cm.Esophageal leiomyomas>5 cm are rare.We describe a case of a large esophageal leiomyoma involving the cardia and diaphragm.CASE SUMMARY A 35-year-old woman presented to the doctor because of a choking sensation after eating.Physical examination showed no positive signs.Gastroscopy indicated an uplifted change in the cardia.Enhanced computed tomography revealed spaceoccupying lesions in the lower part of the esophagus and cardia,which were likely to be malignant.Positron emission tomography–computed tomography showed increased metabolism of soft tissue masses in the lower esophagus and near the cardia.Malignant lesions were considered,and mesenchymal tumors were not excluded.Endoscopic ultrasonography was performed to examine a hypoechoic mass in the lower esophagus,which was unclear from the esophageal wall.Clinical evaluation suggested diagnosis of esophageal and cardiac stromal tumors.Finally,histological specimens obtained by endoscopic ultrasonography–fine needle aspiration suggested leiomyoma.The patient underwent laparoscopic local resection of the tumor.The postoperative pathological diagnosis was leiomyoma.CONCLUSION Endoscopic ultrasonography-fine needle aspiration is necessary for the diagnosis of gastrointestinal leiomyomas.It provides a strong basis for diagnosis of gastrointestinal tumors of unknown nature and origin.

Polymorphisms in tumor necrosis factor genes and susceptibility to esophageal squamous cell carcinoma and gastric cardiac adenocarcinoma in a population of high incidence region of North China

Background We investigated the possible association of the functional polymorphisms in the tumor necrosis factor （TNF） genes with susceptibility to esophageal squamous cell carcinoma （ESCC） and gastric cardiac adenocarcinoma （GCA）.Methods The TNF-α-308G/A and TNF-β ＋ 252G/A single nucleotide polymorphisms （SNPs） were genotyped using polymerase-chain reaction-restriction fragment length polymorphism （PCR-RFLP） analysis, in 555 cancer patients （291 ESCC and 264 GCA） and 437 healthy controls in a high incidence region of North China. Results Among healthy controls, frequencies of the TNF-α 1/1, 1/2 and 2/2 genotypes were 89.4% ,9.2% and 1.4% respectively, while frequencies of the TNF-β B1/B1, B1/B2 and B2/B2 genotypes were 12.6% , 32.3% and 55.1%, respectively. No significant difference was found in the overall genotype and allelotype distribution of the TNF-α-308G/A and TNF-β ＋ 252G/A SNPs among cancer patients and controls. However, both the B1/B1 genotype and B1/B2 genotype significantly increased the risk of developing ESCC [ the age and gender adjusted odds ratio （OR） =2.04 and 1.91, 95% confidence interval （CI） = 1.04 -4.43 and 1.14 - 2.60, respectively] and GCA （the age and gender adjusted OR =2. 68 and 2. 64, 95% CI = 1.14 -6.29 and 1.47 -4.72, respectively） in individuals with negative family history of UGIC, in comparison with the B2/B2 genotype. When the two TNF polymorphisms were combined and analyzed, individuals with the TNF-β B1/B2 and TNF-α1/2 or 2/2 genotypes significantly reduced the risk of developing ESCC and GCA, in comparison with those harboring the TNF-β B2/B2 and TNF-α 1/1 genotypes （ the age and gender adjusted OR = 0.37 and 0. 34, 95% CI =0. 15 -0.92 and 0. 13 -0.90, respectively）. Conclusions Therefore, the TNF-α -308G/A and TNF-β ＋ 252G/A genotyping may be used as a stratification markers to predicate the risk of ESCC and GCA development in North China.

A NEW TECHNIQUE OF ESOPHAGOGASTROSTOMY ABOVE THE AORTIC ARCH—COVERING AND SUSPENDING OF THE ANASTOMOTIC AREA WITH MEDIASTINAL PLEURAL FLAP

The postoperative anastomotic leakage is the most severe complication and the principal cause of death after resection of esophageal carcinoma. Especially, anastomosis above the aorta arch is accompanied by high incidence of anastomotic leakage usually with fatal prognosis. The authors improved the conventional method of anastomosis by using a mediastinal pleural flap to cover and suspend the anastomotic area with excellent result. From January 1990 to April 1995, total 210 patients with esophageal carcinoma underwent surgery resection with this procedure. No anastomotic leakage or stricture developed. Only one patient died of extensive myocardial infarction with an overall mortality of 0.47%. The major merit of this procedure was that the mediastinal pleural flap could cover the area of anastomosis and sustain dragging force acting on this area, providing a better condition for the anastomosis to heal and thus reducing the possibility of anastomotic leakage.

RESULTS ON IVOR-LEWIS ESOPHAGOGASTRECTOMY FOR 338 CASES OF CARCINOMA OF ESOPHAGUS

Three hundred thirty-tight patients with carcinoma in the middle and lower thirds of the esophagus received Ivor-Lewis esophagogastrectomy (separate laparotomy and right thoracotomy incisions) from February 1986 to June 1992. The total resectability was 95.2%. Lymph node metastases were found in 136 cases (40.2%). Postoperative complications developed in 10.3% of the patients. No anastomotic leakage, nor postoperative (within 30 days) death and hospital death occurred. Major pulmonary complications occurred in 28.6% of the patients. The overall 1-, 3- and 5-year survival rate was 88.5% (231/261), 63.1% (125/198) and 48.4% (60/124), respectively. The 5-year survival rate was 64.1% (41/64) in patients with negative lymph nodes as compared to 31.7% (19/60) with positive nodes. The superiority of this technique was a significant improvement of the 5-year survival rate. This was due to better exposure of the operation field which made thorough dissection of lymph nodes possible, especially those along the right recurrent laryngeal nerve. Better operative exposure also provided chances for radical resection with less interference from the aortic arch. It made anastomosis easier to perform so that stenosis and leakage were less likely to occur. Ivor-Lewis esophagogastrectomy was a superior surgical procedure of choice for the treatment of cancer at the lower and middle thirds of the esophagus.

RNA editingof SLC22A3 causes early tumor progression in familial esophageal cancer patients

Subject Code:H16With the support by the National Natural Science Foundation of China,a collaborative study by the Research groups led by Prof.Fu Li(付利)from the Cancer Research Center,Shenzhen University School of Medicine and Prof.Guan Xinyuan(关新元)from the University of Hong Kong reported that an