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Ann Thorac Surg 2007;83:1814-1819
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Immunopathological Patterns of the Stomach in Adenocarcinoma of the Esophagus, Cardia, and Gastric Antrum: Gastric Profiles in Siewert Type I and II Tumors

^a Division of Esophageal and Pulmonary Surgery, Villa Maria Cecilia and San Pier Damiano Hospitals, Cotignola and Faenza (Ravenna), Italy
^b Center for the Study and Therapy of Diseases of the Esophagus (Surgical Section), University of Bologna, Bologna, Italy
^c Department of Oncology and Hematology, Pathology Division, "Felice Addarii" Institute, University of Bologna, Bologna, Italy
^d Department of Surgery, Columbia University, New York, New York

Accepted for publication January 9, 2007.

^_* Address correspondence to Prof Mattioli, Department of Surgery, Intensive Care and Organs Transplantation, University of Bologna, S.Orsola – Malpighi University Hospital, Via G. Massarenti 9, 40138 Bologna, Italy (Email: sandro.mattioli{at}unibo.it).

Background: The morphologic and immunohistochemical profiles of gastric mucosa and of the tumor were assessed in Siewert type I, type II, and gastric antrum adenocarcinomas.

Methods: Sixty-two patients, prospectively operated upon, were included in the study: 37 type II, 15 type I, and 10 antrum adenocarcinoma. Samples of the tumor, the surrounding area, and the gastric corpus and antrum were analyzed histologically, and immunostained for cytokeratins (CK)7/20 (staining positive for cells labeled 50%).

Results: Among the 37 type II adenocarcinomas were the following: (1) 13 of 37 (35%) had intestinal metaplasia (IM) in the stomach; (2) 24 of 37 (65%) did not show IM at any level; (3) 34 of 37 (92%) had Helicobacter Pylori (HP) infection; (4) 13 of 37(35%) had CK7/20 expression of "Barrett’s type" (CK7+/20–); 24 of 37 (65%) had a "no Barrett’s type" profile (10 of 37 with CK7–/CK20+ and 14 of 37 with CK7+/CK20+); (5) 100% showed the same CK immunoprofile, both in IM and adenocarcinoma (measure of agreement k = 1, p = 0.000). Type I adenocarcinomas showed the following: (1) 87.5% CK Barrett’s type, both in the tumor, and in the surrounding IM; (2) 100% gastric samples devoid of both IM and HP infection. Comparison between CK immunoprofiles in type I and type II tumors showed a difference within the two groups (p = 0.002). One hundred percent of antrum adenocarcinomas showed a no Barrett’s type CK profile, both in the tumor and in the IM of the entire stomach.

Conclusions: Data suggest that type II adenocarcinoma cannot be always considered a gastroesophageal reflux disease-related tumor; other pathogenetic pathways should be taken into consideration.