Histopathological features of the gastroesophageal junction: an Eastern view

The definition and features of the gastroesophageal junction (GEJ) and the histopathologic features of the cardiac mucosa remain controversial. Most reports originate from western countries, which have different prevalence of GEJ adenocarcinoma and gastroesophageal reflux disease (GERD) compared to eastern countries. Therefore, we investigated GEJ anatomic and histopathologic features by histological mapping in 30 esophagogastrectomy specimens of middle and lower esophageal squamous cell carcinoma. We measured the lengths of the cardiac mucosa, oxyntocardiac mucosa, and esophageal cardiac-type glands. We assessed the presence of intestinal metaplasia, pancreatic acinar cells, Brunner's-like glands, and submucosal esophageal gland beneath cardiac mucosa and the relationship of these features with age and the circumferential location of cardiac mucosa. The lengths of cardiac mucosa and esophageal cardiac-type glands significantly increased with age (<63 years, 2767.86±734.95 µm vs. ≥63 years, 5453.12±839.52 µm, P=0.025 and <63 years, 1151.78±452.81 µm vs. ≥63 years, 2273.44±321.58 µm, P=0.049, respectively) and the presence of circumferential cardiac mucosa (+, 5731.25±721.57 vs. -, 2625.00±356.00 µm, P=0.007; +, 2425.00±326.13 µm vs. -, 400.00±204.80 µm, P<0.0001 respectively). The presence of intestinal metaplasia and irregular GEJ increased with age and the circumferential location of cardiac mucosa. The presence of esophageal submucosal glands beneath the cardiac mucosa, pancreatic acinar cells, and Brunner-like glands were seen in 8/30 (26.7%), 15/30 (50%), and 14/30 (46.7%) cases, respectively. These data indirectly suggest that cardiac mucosa originated from the distal esophagus and that the presence of cardiac mucosa may indicate GERD, in accordance with data from Western countries.