Cytokeratin phenotyping does not help in distinguishing oesophageal adenocarcinoma from cancer of the gastric cardia.

BACKGROUND: It is sometimes difficult to distinguish between cardia cancer and oesophageal cancer. AIMS: To evaluate whether cytokeratin (CK) expression of the tumour can be of value in differentiating between the two tumour types. METHODS: Consecutive patients with a malignant tumour in the oesophagus or stomach were recruited. Biopsy specimens were taken for routine haematoxylin and eosin staining. One tissue block with representative tissue was selected for immunohistochemical staining (CK7 and CK20). RESULTS: Endoscopically located adenocarcinoma of the oesophagus was present in 84 patients (64 men, 20 women; mean age, 68 years; range, 44-91). Cancer located primarily in the gastric cardia was present in 63 patients (42 men, 21 women; mean age, 68 years; range, 42-88). The histological diagnosis was metastasis from a primary tumour outside the oesophagus or stomach in 19 patients. The patients were divided into three groups for the immunohistochemical analysis. Patients in group A had definite oesophageal cancer, group B patients had a definite carcinoma located in the gastric cardia, and group C patients had an obstructing tumour distal in the oesophagus at the level of the diaphragm, which could not be passed with the endoscope. Paraffin wax embedded material was available from 122 patients for immunostaining and CK analysis. There was no significant difference in expression or distribution of CK7 or CK20 in the three groups of patients. CONCLUSION: CK phenotyping cannot distinguish between cancer arising from a Barrett's oesophagus and carcinoma originating in the gastric cardia.

Diffuse jejunoileitis with vasculitic abnormalities in the mesenteric arteries: a rare manifestation of Crohn's disease.

The case history of a 31-year-old woman with abdominal complaints of long duration is presented. After 4 years and several hospital admissions the patient underwent diagnostic laparotomy and finally a diagnosis of diffuse jejunoileitis as a manifestation of Crohn's disease was made. The diagnostic procedures as well as the therapeutic strategy are described. A review of the literature is given.

Subepithelial collagen thickening in the colon: report on a series of 23 patients.

BACKGROUND: To investigate the prevalence of collagenous colitis in patients presenting with diarrhoea. METHODS: Descriptive retrospective study in consecutive patients under study because of chronic diarrhoea. RESULTS: In a 4.5-year period 23 consecutive patients had histological signs of thickening of the subepithelial collagen band in the colon. There was a female predominance: 19 women versus 4 men, mean age 60 years (range 33-83). The stool frequency was 1-13 stools daily. Indicanuria was present in 9 patients. The patients were divided into 3 groups: those with definite collagenous colitis (n = 11; thickness of the collagen band of more than 10 micrometer); those with indefinite collagenous colitis (n = 8; thickness between 3 and 10 micrometer), and those with a collagen band between 1 and 3 micrometer (n = 4). During a mean follow-up of 20 months (range 13-36), 7 patients had waxing and waning episodes of diarrhoea, 11 showed spontaneous waning of complaints and a lower stool frequency. The 9 patients with indicanuria did well after a course of tetracyclin 250 mg t.i.d., but all cases relapsed during follow-up. CONCLUSION: It is concluded that thickening of the collagen band and collagenous colitis are not as unusual as usually thought.