Surgical pathology of adenocarcinomas arising around or within the gastroesophageal junction.

Dislich, Bastian; Kröll, Dino; Langer, Rupert (2023). Surgical pathology of adenocarcinomas arising around or within the gastroesophageal junction. Updates in surgery, 75(2), pp. 395-402. Springer 10.1007/s13304-022-01360-z

s13304-022-01360-z.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (1MB) | Preview

Classification of adenocarcinomas (AC) arising around or within the gastroesophageal junction (GEJ) is hampered by major morphologic and phenotypic overlaps. We reviewed the surgical pathology of esophagectomy specimens of 115 primary resected AC of the esophagus as defined by the 5th edition of the WHO classification regarding the anatomical site of the tumor, with corresponding categorization according to the Siewert AEG Classification and the preceding 4th edition of the WHO (discriminating esophageal adenocarcinomas/EAC and adenocarcinomas of the gastroesophageal junction/AdGEJ), and further histology findings. In addition, immunohistochemistry (IHC) for CDX2, CK7, CK20, MUC2, MUC5AC and MUC6 was performed. Sixty-eight cases were Siewert AEG type I and 47 cases Siewert AEG type II. Out of the AEG I tumors, 26 were classified as AdGEJ. Regardless of the classification system, more proximally located tumors showed less aggressive behavior with lower rates of lymph node metastases, lymphatic, venous and perineural invasion, better histological differentiation (p < 0.05 each) and were more frequently associated with pre-neoplastic Barrett's mucosa (p < 0.001). Histologically, the tumors displayed intestinal morphology in the majority of cases. IHC showed non-conclusive patterns with a frequent CK7+/CK20+ immunophenotype in all tumors, but also a gastric MUC5AC+ and MUC6+ phenotype in some proximal tumors. In conclusion, histology of the tumors and IHC failed to distinguish reliably between more proximal and more distal tumors. The presence of Barrett's mucosa rather than location alone, however, may help to further differentiating adenocarcinomas arising in this region and may be indicative for a particular biologic type.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Service Sector > Institute of Pathology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Dislich, Bastian, Kröll, Dino, Langer, Rupert


500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health








Pubmed Import

Date Deposited:

25 Aug 2022 17:24

Last Modified:

21 Jan 2023 00:13

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Adenocarcinoma Biomarker Esophagus Gastroesophageal junction Intestinal metaplasia Surgical pathology




Actions (login required)

Edit item Edit item
Provide Feedback