BACKGROUND & AIMS: :We present a 47-year-old patient with progressive dysphagia. Upper gastro intestinal endoscopy revealed middle third esophageal ulcer, the histology of which was moderately differentiated carcinoma. The patient underwent 3-stage esophagectomy with cervical gastro esophageal anastomosis. The histopathology revealed Crohn's disease of the esophagus. The clinical features and diagnosis of this rare condition are described, with review of the literature.

背景与目标： ：我们介绍了一名47岁的进行性吞咽困难患者。上消化道内镜检查发现中段食管溃疡，其组织学为中度分化癌。该患者接受了三阶段食管切除术并进行了胃食管颈吻合术。组织病理学揭示了食道的克罗恩氏病。结合文献回顾，描述了这种罕见病的临床特征和诊断。

BACKGROUND & AIMS: :The present study was designated to analyze correlation between the presence and extent of peritumoral retraction clefting and various clinicopathologic features in esophageal squamous cell carcinoma (ESCC), and to possibly establish the significance of this phenomenon in ESCC. Fifty-four consecutive patients with advanced ESCC were included in the study. The presence of peritumoral retraction clefting was classified on the basis of the proportion of tumor nests exhibiting this phenomenon. Tumors with clefts that affected up to 25% of tumor nests were classified as group I; with clefts that affected >25% to 50% of tumor nests as group II; with clefts that affected >50% to 75% of tumor nests as group III; and tumors with clefts that affected more than 75% of tumor nests were classified as group IV. Statistical analysis showed a correlation between presence and extent of peritumoral clefting and lymph node metastasis. T3 tumors and tumors with lymph node metastasis had significantly more pronounced peritumoral clefting compared with T2 tumors and tumors without lymph node metastasis. The presence of peritumoral clefting was not associated with the number of affected lymph nodes. There was no correlation between the presence and extent of peritumoral clefting with patient age and sex, and tumor location, diameter and grade. The association of peritumoral retraction clefting in ESCC with local invasiveness and lymph node metastasis indicated that peritumoral clefting could be a simple and useful morphological feature of tumor aggressiveness and may contribute to the pathological and clinical assessment of patients with ESCC.

背景与目标： ：本研究旨在分析食管鳞状细胞癌（ESCC）肿瘤周围回缩裂隙的存在和程度与各种临床病理特征之间的相关性，并可能确定这种现象在ESCC中的意义。这项研究包括了54名连续的晚期ESCC患者。根据表现出这种现象的肿瘤巢的比例，对肿瘤周围收缩性裂隙的存在进行分类。裂隙最多影响25％的肿瘤巢的肿瘤被归为第一组。 II组裂隙影响大于2​​5％至50％的肿瘤巢；第三组裂隙影响> 50％至75％的肿瘤巢；裂隙累及超过75％肿瘤巢的肿瘤被归为IV组。统计分析表明，肿瘤周围裂隙的存在与程度与淋巴结转移之间存在相关性。与T2肿瘤和无淋巴结转移的肿瘤相比，T3肿瘤和有淋巴结转移的肿瘤的肿瘤周裂明显更为明显。肿瘤周围裂隙的存在与受影响的淋巴结数目无关。肿瘤周裂的存在与程度，患者年龄和性别与肿瘤的位置，直径和等级之间没有相关性。 ESCC肿瘤周围收缩traction裂与局部浸润性和淋巴结转移的关系表明，肿瘤周围裂隙可能是肿瘤侵袭性的一种简单而有用的形态学特征，可能有助于ESCC患者的病理和临床评估。

BACKGROUND & AIMS: BACKGROUND AND GOALS:Acute food bolus impaction is a common emergency in gastrointestinal practice. Management previously used the endoscope with an overtube to allow retrieval of the bolus per os. The push technique using air insufflation and gentle pressure on the bolus provides an alternative approach. Esophageal mucosal biopsy at the time of the initial endoscopy has not been a part of traditional practice. In view of the increasing recognition of eosinophilic esophagitis (EE) as a cause of dysphagia and food bolus obstruction in adults the etiology needs to be reassessed. STUDY:Forty-three consecutive adults presenting with acute dysphagia secondary to food bolus obstruction of the esophagus were studied. The bolus was advanced into the stomach with the push technique or removed per os with a retrieval net. Protocol biopsies from the proximal and distal esophagus were obtained in 29 patients. Biopsies were contraindicated or not obtained in the remainder. RESULTS:Forty-one patients were successfully treated at endoscopy. Two subjects with a food bolus impacted at the crico-pharyngeal region required general anesthesia with endotracheal intubation for safe removal. Of 29 patients biopsied, 15 had peptic esophageal stricture as the cause. Fourteen patients (all males, mean age 32 y, range 19 to 62 y) had EE identified histologically. This represents 50% of those biopsied. Patients with EE had typical endoscopic features of linear furrows, mucosal rings, or narrow bore esophagus. Most had prior episodes of food bolus obstruction. CONCLUSIONS:Food bolus obstruction can be safely managed by the push technique. EE is an important cause of food bolus obstruction that can be suspected on history and endoscopic appearance and confirmed on histology.

背景与目标： 背景与目标：急性食物推注撞击是胃肠道实践中的常见紧急情况。管理层先前将内窥镜与套管配合使用，以允许每OS取出弹丸。使用充气和轻推推注的推压技术提供了另一种方法。初次内镜检查时的食管粘膜活检尚未成为传统做法的一部分。鉴于越来越多的人认识到嗜酸性粒细胞性食管炎（EE）是导致吞咽困难和食物弹药阻塞的原因，因此需要重新评估病因。
研究：研究了连续四十三名因食管食物团阻塞而继发急性吞咽困难的成年人。通过推挤技术将大丸药推入胃中，或通过回弹网将其快速清除。 29例患者从近端食管和远端食管获得了活检标本。在其余患者中禁用或未获得活检标本。
结果：在内窥镜检查中成功治疗了41例患者。两名在食管咽部区域受到食物推注的受试者需要使用气管插管进行全身麻醉，以安全移除。在29例活检患者中，有15例是由于消化道食管狭窄引起的。 14例患者（均为男性，平均年龄32岁，范围19至62岁）在组织学上被确定为EE。这占活检样本的50％。 EE患者的典型内窥镜特征为线性犁沟，粘膜环或狭窄口食管。多数患者以前曾发生过食物弹药阻塞。
结论：推药技术可以安全地控制食物团。 EE是食物团阻塞的重要原因，可在病史和内窥镜外观上被怀疑并在组织学上得到证实。

BACKGROUND & AIMS: AIM:To clarify risk based upon segment length, diagnostic histological findings, patient age and year of surveillance, duration of surveillance and gender. METHODS:Patients registered with the United Kingdom Barrett's Oesophagus Registry from 9 United Kingdom centers were included. The outcome measures were (1) development of all grades of dysplasia; (2) development of high-grade of dysplasia or adenocarcinoma; and (3) development of adenocarcinoma. Prevalent cases and subjects with < 1 year of follow-up were excluded. The covariates examined were segment length, previous biopsy findings, age at surveillance, duration of surveillance, year of surveillance and gender. RESULTS:One thousand and one hundred thirty six patients were included (total 6474 patient-years). Fifty-four patients developed adenocarcinoma (0.83% per annum), 70 developed high-grade dysplasia/adenocarcinoma (1.1% per annum) and 190 developed any grade of dysplasia (3.5% per annum). High grade dysplasia and adenocarcinoma increased with age and duration of surveillance. The risk of low-grade dysplasia development was not dependent on age at surveillance. Segment length and previous biopsy findings were also significant factors for development of dysplasia and adenocarcinoma. CONCLUSION:The risk of development of low-grade dysplasia is independent of age at surveillance, but high-grade dysplasia and adenocarcinoma were more commonly found at older age. Segment length and previous biopsy findings are also markers of risk. This study did not demonstrate stabilisation of the metaplastic segment with prolonged surveillance.

背景与目标： 目的：根据段长，诊断组织学发现，患者年龄和监测年限，监测持续时间和性别来明确风险。
方法：包括来自英国9个中心的英国Barrett食管登记处注册的患者。结局指标包括：（1）所有级别的发育异常的发展； （2）发展为高度不典型增生或腺癌； （3）腺癌的发展。排除＜1年随访的普遍病例和受试者。检验的协变量是节段长度，既往活检结果，监测年龄，监测持续时间，监测年份和性别。
结果：共纳入136例患者（总计6474例患者-年）。 54名患者发展为腺癌（每年0.83％），70名发展为高度不典型增生/腺癌（每年1.1％），190个发展为任何等级的不典型增生（每年3.5％）。高度不典型增生和腺癌随着年龄和监测持续时间的增加而增加。低度发育异常发展的风险不取决于监测时的年龄。节段长度和先前的活检结果也是发育异常和腺癌发展的重要因素。
结论：在监测时，低度发育不良的发展风险与年龄无关，但高度发育异常和腺癌在老年人中更为常见。节段长度和先前的活检结果也是危险的标志。这项研究没有证明通过长时间的监测可以稳定化生段。

BACKGROUND & AIMS: :The reproducibility of ambulatory 24-h esophageal pH monitoring was evaluated in 16 consecutive patients by comparing the difference in two consecutive 24-h periods. The study group included 8 patients with scleroderma esophagus and 8 treated achalasia patients. The amount of reflux was expressed as the percentage of time the pH was < 4.0. Both groups demonstrated excellent intrapatient reproducibility overall: 96% in scleroderma patients and 95% in those patients with achalasia. The least concordance was found in the lengths of the longest reflux events-70% when supine in scleroderma patients and 59% when upright in patients with achalasia. There was no significant difference (p > 0.05) between day 1 and day 2 for either group of patients for any of the elements studied. These results indicate that intrapatient variability of gastroesophageal reflux in patients with scleroderma esophagus and treated patients with achalasia is very low and following therapeutic intervention, a high level of confidence can be placed in subsequent pH monitoring as an indicator of treatment effect.

背景与目标： ：通过比较两个连续的24小时内的差异，对16例连续患者进行了动态24小时食管pH监测的可重复性。研究组包括8例食管硬皮病患者和8例接受治疗的门失弛缓患者。回流量表示为pH ＜4.0的时间百分比。两组患者总体上均具有出色的可重复性：硬皮病患者中96％，门失弛缓患者中95％。在最长的反流事件的时间长度上发现的一致性最低—硬皮病患者仰卧时为70％，门失弛缓患者为直立时为59％。两组患者在第1天和第2天之间没有任何显着差异（p> 0.05）。这些结果表明，食管硬皮病患者和经治疗的treated门失弛缓患者的胃食管反流患者的变异性非常低，在进行治疗干预后，可以在随后的pH监测中置信度高，作为治疗效果的指标。

BACKGROUND & AIMS: :Esophageal involvement of pemphigus vulgaris (PV) had been considered an exceptional event. We present the case of a woman with PV who developed esophageal involvement while being treated with azathioprine and resolved after steroid therapy. This case highlights that esophageal involvement of PV might be resistant to immunosuppressive therapy other than steroids.

背景与目标： ：寻常性天疱疮（PV）的食道受累被认为是例外事件。我们介绍了一名患有PV的妇女，该妇女在接受硫唑嘌呤治疗时出现食管受累，并在类固醇治疗后消退。该病例表明，食管PV的介入除类固醇外可能对免疫抑制疗法有抵抗力。

BACKGROUND & AIMS: :Barrett's esophagus (BE) refers to an abnormal change (metaplasia) in the cells of the inferior portion of the esophagus. About 10% of patients with symptomatic gastroesophageal reflux disease (GERD) have BE. In some cases, BE develops as an advanced stage of erosive esophagitis. The risk of esophageal cancer appears to be increased in patients with BE. The only way to diagnose BE is by endoscopy and histology. Some studies suggest that intensive treatment of Barrett's esophagus with effective acid suppression can reduce the amount of abnormal lining in the esophagus. It is not clear whether such treatment also prevents esophageal cancer. Generally, the cancer starts out as carcinoma of the esophagus on the surface, and then invades the surrounding tissue. Surgery offers the best chance of long-term survival. There are many events that occur in Barrett's esophagus that lead to the development of cancer and most of them appear to occur early, before high-grade dysplasia or cancer develops. No one knows what the late events are and how cells acquire the ability to leave their normal growth boundaries. It is now widely accepted that the development of most cancers is due to something called genomic or genetic instability. The aim of this review is to show BE pathology in its progression to cancer looking for new biomarkers to distinguish between BE -dysplasia (low grade and high grade)- adenocarcinoma (ADC) and to characterize the ADC, giving more hope for its treatment.

背景与目标： ：Barrett食道（BE）是指食道下半部分细胞的异常变化（异化症）。有症状的胃食管反流病（GERD）的患者中约有10％患有BE。在某些情况下，BE发展为糜烂性食管炎的晚期。 BE患者食管癌的风险似乎增加。诊断BE的唯一方法是通过内窥镜检查和组织学检查。一些研究表明，用有效的抑酸剂对巴雷特食管进行强化治疗可以减少食管中异常内膜的数量。尚不清楚这种治疗方法是否还可以预防食道癌。通常，癌症从表面食道癌开始，然后侵入周围组织。手术提供了长期生存的最佳机会。在巴雷特食管中发生了许多事件，导致癌症的发展，并且大多数事件似乎发生在严重的不典型增生或癌症发展之前。没有人知道晚期事件是什么，以及细胞如何获得脱离正常生长边界的能力。现在已被广泛接受，大多数癌症的发生是由于所谓的基因组或遗传不稳定性。这篇综述的目的是展示BE病理学向癌症发展的过程，以寻找新的生物标志物来区分BE-发育异常（低度和高度）-腺癌（ADC）并鉴定ADC的特征，从而为其治疗带来更多希望。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: Background/Aims:The aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and 13C-acetate breath test (13C-ABT) analyses. Methods:13C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the 13C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t1/2, 90-170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t1/2. Results:The mean t1/2 of all patients was 215.5 ± 237.2 minutes and the t1/2 of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t1/2 and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t1/2 ≥ 140 minutes. Conclusion:The present study demonstrated that GE with t1/2 ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD.

背景与目标： 背景/目的：本研究的目的是研究延迟胃排空的程度（DGE），并评估DGE的严重程度如何利用24小时多通道腔内阻抗pH对神经功能障碍（NI）患者的胃食管反流病（GERD）产生影响测量（pH / MII）和13C醋酸呼气试验（13C-ABT）分析。
方法：对26例因疑似GERD而转入本院的NI患者进行了13C-ABT和pH / MII检查。首先，进行相关分析以研究13C-ABT参数与临床或pH / MII参数之间的相关性。此后，根据每个患者的半个排空时间（t1 / 2、90-170分钟）将所有患者分为2组（DGE和严重DGE [SDGE]组）。在每个设定截止时间t1 / 2中，将两组的每个pH / MII参数进行了比较。
结果：所有患者的平均t1 / 2为215.5±237.2分钟，而24位患者（92.3％）的t1 / 2为> 100分钟。在t1 / 2和滞后时间与非酸回流相关参数之间均观察到显着的正相关。此外，当截断时间为t1 / 2≥140分钟时，SDGE组的患者显示出比DGE组更高的非酸性反流相关参数。
结论：本研究表明，t1 / 2≥140分钟的GE与NI患者中非酸暴露至食管近端的增加有关，并且表明SDGE的NI患者可能具有较高的非酸暴露风险。酸GERD。

BACKGROUND & AIMS: BACKGROUND & AIMS:Barrett's esophagus is a precursor of esophageal adenocarcinoma. DNA microarrays that enable a genome-wide assessment of gene expression enhance the identification of specific genes as well as gene expression patterns that are expressed by Barrett's esophagus and adenocarcinoma compared with normal tissues. Barrett's esophagus length has also been identified as a risk factor for progression to adenocarcinoma, but whether there are intrinsic biological differences between short-segment and long-segment Barrett's esophagus can be explored with microarrays. METHODS:Gene expression profiles for endoscopically obtained biopsy specimens of Barrett's esophagus or esophageal adenocarcinoma and associated normal esophagus and duodenum were identified for 17 patients using DNA microarrays. Unsupervised and supervised approaches for data analysis defined similarities and differences between the tissues as well as correlations with clinical phenotypes. RESULTS:Each tissue displays a unique expression profile that distinguishes it from others. Barrett's esophagus and esophageal adenocarcinoma express a unique set of stromal genes that is distinct from normal tissues but similar to other cancers. Adenocarcinoma also showed lower and higher expression for many genes compared with Barrett's esophagus. No difference in gene expression was found between short-segment and long-segment Barrett's esophagus. CONCLUSIONS:The genome-wide assessment provided by current DNA microarrays reveals many candidate genes and patterns not previously identified. Stromal gene expression in Barrett's esophagus and adenocarcinoma is similar, indicating that these changes precede malignant transformation.

背景与目标： 背景与目的：巴雷特食管是食管腺癌的前体。与正常组织相比，能够对基因表达进行全基因组评估的DNA微阵列可增强对特定基因以及巴雷特食管和腺癌所表达的基因表达模式的识别。 Barrett食管的长度也被确定为发展为腺癌的危险因素，但是短段和长段Barrett食管之间是否存在固有的生物学差异可以通过微阵列探索。
方法：使用DNA微阵列技术，通过内窥镜检查获得的Barrett食管或食道腺癌及相关正常食管和十二指肠活检标本的基因表达谱，共鉴定出17例患者。用于数据分析的无监督和监督方法定义了组织之间的异同以及与临床表型的相关性。
结果：每个组织均显示出独特的表达特征，以区别于其他组织。巴雷特食管和食道腺癌表达一组独特的基质基因，与正常组织不同，但与其他癌症相似。与巴雷特食管相比，腺癌在许多基因中也表现出较低和较高的表达。在短段和长段巴雷特食管之间未发现基因表达差异。
结论：当前DNA微阵列提供的全基因组评估揭示了许多以前未发现的候选基因和模式。巴雷特食管和腺癌的基质基因表达相似，表明这些改变先于恶性转化。

BACKGROUND & AIMS: :We report a severe case of cytomegalovirus (CMV) esophagitis in a renal transplant recipient presenting as acute esophageal necrosis (AEN, 'black esophagus'). AEN is an uncommon entity that is a result of mucosal necrosis and has been described only a few times previously. To our knowledge, this is the first report of AEN due to a CMV infection. The disease was manifested by abdominal and epigastric pain, thrombocytopenia, leukopenia, and elevated liver enzymes. Upper endoscopy showed acute esophageal necrosis. Ganciclovir therapy was initiated immediately and resulted in a complete remission of symptoms. We conclude that the possibility of CMV infection should be suspected in any patient presenting with cytopenia, elevated liver enzymes, and epithelial gastrointestinal lesions in the first 6 months after transplantation, and that early viral detection and antiviral therapy can be lifesaving.

背景与目标： ：我们报道一名肾移植受者出现严重的巨细胞病毒（CMV）食管炎病例，表现为急性食管坏死（AEN，“黑色食道”）。 AEN是粘膜坏死的罕见实体，此前仅被描述过几次。据我们所知，这是由于CMV感染引起的AEN的首次报道。该疾病表现为腹痛和上腹痛，血小板减少症，白细胞减少症和肝酶升高。上镜检查可见急性食管坏死。更昔洛韦治疗立即开始，导致症状完全缓解。我们得出的结论是，在移植后的前6个月内出现血细胞减少，肝酶升高和上皮胃肠道病变的任何患者均应怀疑CMV感染的可能性，并且早期病毒检测和抗病毒治疗可以挽救生命。

BACKGROUND & AIMS: :Synchronous involvement of the esophagus, stomach, and small intestine by peptic ulceration has not been previously described in the Zollinger-Ellison syndrome. Two patients presented with abdominal pain, diarrhea, weight loss, and dysphagia while on acid suppressants. Fasting hypergastrinemia was confirmed. Endoscopy revealed peptic stricture of the esophagus with ulcerations in the stomach, duodenum, and jejunum. Imaging showed a mass in the head of pancreas. The first patient underwent distal esophagectomy, total gastrectomy, and resection of the head of pancreas for a pancreatic primary. Resection of the third and fourth parts of the duodenum and proximal jejunum was undertaken in the second patient with a duodenal primary. Malignant gastrinoma was confirmed histologically. "Supergastrinoma" describes a tumor causing synchronous peptic ulceration and/or stricture extending from the esophagus to the jejunum. Operative management entails customized resection of the areas irretrievably damaged by the ulceration together with the tumor.

背景与目标： ：Zollinger-Ellison综合征以前没有描述消化性溃疡引起食管，胃和小肠的同时受累。两名患者在使用抑酸剂时出现腹痛，腹泻，体重减轻和吞咽困难。确认禁食高胃泌素血症。内窥镜检查显示食管的消化道狭窄，胃，十二指肠和空肠有溃疡。影像学检查显示胰头有肿块。首例患者接受了远端食管切除术，全胃切除术以及胰腺原发性胰腺切除。在第二例十二指肠原发患者中切除十二指肠的第三和第四部分以及空肠近端。在组织学上证实为恶性胃泌素瘤。 “上胃泌素瘤”描述了引起从食道到空肠的同步消化性溃疡和/或狭窄的肿瘤。手术管理需要对因溃疡和肿瘤而无法修复的区域进行定制切除。

BACKGROUND & AIMS: :Forty-seven biopsies of gastric mucosa and Barrett esophagus from 32 patients were studied with the argyrophilic nucleolar organizer region method. Twenty-two biopsies were gastric and 25 esophageal. Four showed normal noninflamed mucosa, 14 reactive glandular changes, eight intestinal metaplasia without dysplasia, ten low grade dysplasia with intestinal metaplasia, and 11 high grade dysplasia. The mean number of nucleolar organizer regions was 14.9 for high grade dysplasia, 10.9 for low grade dysplasia, 8.5 for intestinal metaplasia without dysplasia, 6.7 for reactive changes, and 3.9 for normal mucosa. The difference between high grade dysplasia and the other groups was significant (P = 0.004). However, the difference between high and low grade dysplasia was not significant (P = 0.06), and there was an overlap between reactive and high grade dysplastic lesions. We conclude that although nucleolar organizer counts correlate with the degree of dysplasia, the technique is of limited practical use.

背景与目标： ：使用嗜银核仁组织区法研究了32例胃黏膜和Barrett食管的47例活检。胃活检22例，食管活检25例。 4例显示正常的非炎性粘膜，14例反应性腺体变化，8例无异型增生的肠化生，10例伴肠化生的低度异型增生和11例高度异型增生。高度不典型增生的核仁组织者区域平均数为14.9，低高度不典型增生的平均核仁组织区数目为10.9，无不典型增生的肠上皮化生为8.5，反应性改变为6.7，正常粘膜为3.9。高度不典型增生与其他组之间的差异是显着的（P = 0.004）。然而，高，低度增生异常之间的差异不显着（P = 0.06），而反应性和高度增生异常病变之间存在重叠。我们得出结论，尽管核仁组织者计数与发育异常的程度相关，但该技术的实际应用有限。

BACKGROUND & AIMS: :A 67-year-old woman was treated with neoadjuvant chemotherapy, esophagectomy, and subsequent radiotherapy for T3N1 poorly differentiated adenocarcinoma of the esophagus. Five months after surgery, a routine follow-up CT demonstrated a 1.2-cm soft tissue mass in the posterior mediastinum suspicious for local recurrence. An FDG-PET/CT study confirmed tumor in the posterior mediastinum and also showed focal areas of increased tracer uptake within several muscles. Skeletal muscle is one of the most unusual sites of metastatic disease, although it is probable that the more frequent use of FDG-PET imaging will lead to an increase in the detection of such lesions.

背景与目标： ：一名67岁妇女接受了新辅助化疗，食管切除术以及随后的T3N1食管低分化腺癌放疗。手术后五个月，常规随访CT显示后纵隔有1.2厘米的软组织肿块，可疑为局部复发。 FDG-PET / CT研究证实了纵隔后部的肿瘤，并且还显示了一些肌肉中示踪剂摄取增加的病灶区域。骨骼肌是最常见的转移性疾病之一，尽管FDG-PET成像的更频繁使用可能会导致此类病变的检测增加。

BACKGROUND & AIMS: :Barrett's esophagus is a useful model for the study of carcinogenesis, as the metaplastic columnar epithelium that replaces squamous esophageal epithelium is at elevated risk for development of adenocarcinoma. We examined telomere length and chromosomal instability (CIN) in Barrett's esophagus biopsies using fluorescence in situ hybridization. To study CIN, we selected centromere and locus-specific arm probes to chromosomes 17/17p (p53), 11/11q (cyclin D1), and 9/9p (p16 INK4A), loci reported to be involved in early stages of Barrett's esophagus neoplasia. Telomere shortening was observed in Barrett's esophagus epithelium at all histologic grades, whereas CIN was highest in biopsies with dysplastic changes; there was, however, considerable heterogeneity between patients in each variable. Alterations on chromosome 17 were strongly correlated with telomere length (r = 0.55; P < 0.0001) and loss of the 17p arm signal was the most common event. CIN on chromosome 11 was also associated with telomere shortening (r =0.3; P = 0.05), although 11q arm gains were most common. On chromosome 9p, arm losses were the most common finding, but chromosome 9 CIN was not strongly correlated with telomere length. We conclude that CIN is related to telomere shortening in Barrett's esophagus but varies by chromosome. Whether instability is manifested as loss or gain seems to be influenced by the chromosomal loci involved. Because telomere shortening and CIN are early events in Barrett's esophagus neoplastic progression and are highly variable among patients, it will be important to determine whether they identify a subset of patients that is at risk for more rapid neoplastic evolution.

背景与目标： ：Barrett食管是研究癌变的有用模型，因为化生的柱状上皮代替了鳞状食管上皮，因此罹患腺癌的风险较高。我们使用荧光原位杂交技术检查了巴雷特食管活检中的端粒长度和染色体不稳定性（CIN）。为了研究CIN，我们选择了着丝粒和特定位点的臂探针来检测染色体17 / 17p（p53），11 / 11q（cyclin D1）和9 / 9p（p16 INK4A），这些基因座据报道与Barrett食道的早期阶段有关。瘤形成。在所有组织学级别的巴雷特食管上皮中均观察到端粒缩短，而在具有增生异常变化的活检中，CIN最高。但是，每个变量的患者之间存在相当大的异质性。 17号染色​​体的改变与端粒长度密切相关（r = 0.55； P <0.0001），最常见的事件是17p臂信号丢失。尽管11q臂增加最常见，但11号染色体上的CIN也与端粒缩短有关（r = 0.3; P = 0.05）。在9p染色体上，臂丢失是最常见的发现，但是9号染色体CIN与端粒长度没有强烈关系。我们得出结论，CIN与Barrett食道中的端粒缩短有关，但随染色体而变化。不稳定性是否表现为损失或增加似乎受所涉及的染色体位点的影响。由于端粒缩短和CIN是Barrett食道癌进展中的早期事件，并且在患者之间变化很大，因此确定他们是否识别出有可能出现较快速肿瘤发展风险的患者子集非常重要。