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Prolyl hydroxylases (PHD) inhibitors have been observed to normalise blood vessels and increase drug distribution in mice tumour, which increases the effectivity of chemotherapy. However, these effects are yet to be demonstrated in human models. Herein, we developed a vascularised tumouroid-on-a-chip that closely resembles the tumour microenvironment in vivo and demonstrate that the addition of the PHD inhibitor dimethyloxallyl glycine (DMOG) prevents the degradation of normal blood vessels and enhances the efficacy of the chemotherapy drugs paclitaxel and cisplatin in human oesophageal carcinoma tumouroids. Our results suggest that vascularised tumours-on-chips are effective models to evaluate chemotherapeutic drugs under the synergistic effect of a vasoprotective drug.

Background There are currently limited data on the comparative success of endoscopic laser therapy (NLT) and self expanding metal stents (SEMS) as palliative measures in patients with non-resectable oesophageal cancer. This study aims to assess and compare the outcomes of these methods of endoscopic palliation. Methods Patients with non-curative oesophageal/gastro-oesophageal cancers with dysphagia were identified prospectively and consented to swallow assessment and follow-up. Patients underwent SEMS or NLT at the discretion of the treating endoscopist. Initial standardised swallow scores (0–4) were assessed. All subsequent interventions were recorded as well as survival. Results 31 patients were recruited (30M vs 8F, mean age 70.8). There was no significant difference in age, sex or chemotherapy treatment between groups. 19(61%)patients underwent NLT as primary procedure. 20(64.5%) patients required subsequent intervention(s) (median 1, range 0–8). Primary NLT patients were more likely to require subsequent therapy (p = 0.004) and multiple procedures (p = 0.001). 8(42.1%)patients initially undergoing NLT subsequently required SEMS, while no SEMS patients underwent subsequent NLT. Swallow scores of 1 or 2 were more likely to be maintained with NLT while scores of 3 or 4 were more likely to progress to SEMS (p = 0.039). Time to repeat procedure was greater in the SEMS group (p = 0.001). Median survival was 133 days for NLT vs 60 days for SEMS (p = 0.412). Conclusion In this series, patients selected for NLT had a trend towards longer survival, but were more likely to require repeated procedures. Those with lower early initial dysphagia scores were more likely to be maintained by NLT alone.

Introduction and importance This case report describes postoperative complications in a patient after hybrid oesophagectomy for oesophageal carcinoma after COVID pneumonia. The global COVID-19 pandemic affected cancer patients indicated for surgery. Covid 19 may worsen the results of oesophageal cancer surgery. More similar studies are needed. Case presentation A 69-year-old male was diagnosed with squamous cell carcinoma of the middle oesophagus based on PET/CT without disease generalisation. His stenotic tumour required a nutritive jejunostomy, with subsequent neoadjuvant radiochemotherapy indicated according to the CROSS protocol. The patient developed COVID pneumonia during the cancer therapy. After managing the COVID pneumonia, oncological therapy was completed and a hybrid oesophagectomy was performed 8 weeks later. Serious complications (respiratory failure, septic shock, anastomosis dehiscence) developed during the postoperative period. All complications were managed therapeutically. The patient was type IVb according to the Clavien-Dindo classification. Clinical discussion Postoperative complications may develop in any patient operated for oesophageal carcinoma, especially if high-risk predictive factors are present. The question arises as to how much the post-COVID condition affected the onset of these serious complications. Conclusion Post-COVID patients are at a risk of developing post-COVID syndrome, which may lead to a wide range of symptoms in the affected organs. Further studies on the relationship between COVID-19 and oesophagectomy for oesophageal carcinoma will be necessary to clarify the relationship between the complications during the postoperative period in patients with oesophageal malignancy.

Highlights • Small intestinal metastasis from oesophageal carcinoma is extremely rare. • Most cases of it involve male patients with squamous cell carcinoma. • Most cases are associated with ileus or perforation with fatal outcome. • The combination of resection and chemo-radio-therapy seems to be essential., Introduction Small intestinal metastasis from oesophageal carcinoma is rare. We report a case of small intestinal metastases from oesophageal carcinoma presenting as a perforation and discuss the aetiology with other cases of small intestinal metastasis from oesophageal carcinoma reported in previous literature. Presentation An 86-year-old man presented with fever and coughing. He had choked while eating and had history of weight loss. He was diagnosed with aspiration pneumonia. Two days after the admission, he complained of abdominal pain. Physical examination revealed guarding and rebound tenderness in the upper abdomen. A contrast computed tomography of the abdomen showed ascites, free air, and irregular thickness of the small intestinal walls. Small intestinal perforation was noted, and surgical resection of the small intestine was performed. The pathological findings of the resected small intestine revealed ulcers with squamous cell carcinoma, and upper gastrointestinal endoscopy demonstrated oesophageal tumour, whose biopsy revealed squamous cell carcinoma. A diagnosis of small intestinal metastases from oesophageal carcinoma was made, but the patient died one month after the diagnosis. Discussion Most cases found in the literature of oesophageal tumour involve squamous cell carcinoma with male patients, and specific symptoms are divided into obstruction and perforation. All patients with small intestinal metastasis from oesophageal carcinoma who survived were treated by a combination of resection and radiation and/or chemotherapy; thus, immediate treatments seem essential to improve the prognosis. Conclusion Physicians should keep in mind the possibility of small intestinal metastasis when patients with a history of oesophageal cancer have abdominal symptoms.

Various domestic or industrial chemicals may cause significant upper aerodigestive tract burns. Preventive measures should be up-scaled, especially in the developing world, to reduce the epidemic of accidental victims, largely unsupervised preschool children. External signs do not predict degree of injury. Non-invasive diagnostic screening includes radio-nuclear imaging, but early oesophago-gastroduodenoscopy remains the standard to predict stricture formation from circumferential submucosal scarring. Serial dilation is the mainstay of oesophageal stricture therapy, with oesophageal replacement reserved for severe refractory strictures. Intra-lesional steroid or mitomycin C may decrease the dilatations required for severe strictures, although long-term effects are unknown. Risk of secondary oesophageal carcinoma mandates long-term surveillance.

The discovery of Pt-chlorin-type theranostic agents is described. Luminescent Pt(II) 4,5,6,7-tetrahydropyrazolo[1,5-a]pyridine-fused chlorins, with different degrees of hydrophilicity, have been synthesized and their in vitro photocytotoxicity against human melanoma, oesophageal and bladder carcinomas was studied. A di(hydroxymethyl)-substituted chlorin was identified as a privileged molecule to explore imaging-guided photodynamic therapy. In addition to the high activity as PDT agent and absence of cytotoxicity per se, this molecule showed the ideal photophysical and photochemical properties. In vivo studies using a A375 melanoma mouse model, proved the extraordinary properties of this chlorin as a luminescent probe and the ability to impair tumor growth, making image guided treatment and follow up a possibility.

Introduction A large number of patients present in Otolaryngology clinics with vague upper gastro intestinal symptoms, some potentially originating from the oesophagus. In the United Kingdom there is no consensus for investigation protocols. The concern is that diagnosis of early oesophageal malignancy can be delayed with detrimental effects to the prognosis of the patient. The aim of this paper is to attempt to establish the impact of Ear Nose and Throat (ENT) work up in the diagnostic pathway of these patients. Methods Retrospective analysis of case notes of newly diagnosed oesophageal carcinoma over a 15 month period. Results Sixty five patients with a new diagnosis of oesophageal carcinoma were identified from the upper GI cancer network. A cohort of 7 patients was initially referred to ENT with related symptoms. Delays occurred at different stages during the course of their diagnostic pathways. Only 2 patients were diagnosed from ENT prior to referral to upper GI. Conclusion We support the creation of one stop clinics incorporating the use of transnasal oesophagoscopy. The current literature is discussed.

Purpose The aim of this study was to systematically review published data on the efficacy of positron emission tomography–computed tomography (PET–CT) in the radiotherapy planning process of patients with oesophageal carcinoma. Methods A systematic search of the PubMed, CINAHL, Cochrane Library and ScienceDirect databases was performed. The quality of the included studies was appraised using validated assessment tool. Data of the studies were synthesized, compared and evaluated by constructing evidentiary tables. Results The 37 included studies, comprising a total sample size of 1921 patients, had moderate methodological quality. Overall primary tumour detection rate was 92.7%, and pooling estimate of specificity was 88% (95%CI: 83–91%) for local lymph node metastasis. The pooled studies presented heterogeneity for sensitivity ( p Conclusions PET–CT has a high specificity but due to its variable sensitivity, information from other clinical investigations should still be sought. Discretion and sound clinical judgment must also be exercised before using the biologic information for radiotherapy planning.

In this current issue of Radiotherapy and Oncology, two papers are published which show a detrimental impact of delay between initial imaging for diagnosis and treatment planning for radiotherapy on tumour progression and treatment outcome [1,2]. In a substantial portion of 45 investigated patients suffering from oesophageal carcinoma Mujis and colleagues demonstrated that SUVmax, tumour length or TNM status progressed during the elapsed 8–49 days between diagnostic PET-CT and re-imaging PET-CT for treatment planning [1]. In a similar study on 21 patients with non-small cell lung cancer Everitt et al. showed that gross tumour volume approximately doubled between two pre-treatment PET-CTs, in median 23 days apart, with six patients being unsuitable for radical radiotherapy after the second PET-CT [2]. These two papers add to a significant body of evidence corroborating the importance of delays and overall treatment time for applicability and outcome of curative radiotherapy. As this detrimental impact of time can at least partly be prevented, it is useful to categorise the evidence and potential counteracting measures in order to achieve optimal therapeutic results (Fig. 1)

Integrated positron-emission tomography/computed tomography (PET/CT) with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG) is now established in the management of oncology patients. With increasing availability and a constantly advancing body of evidence, the role of FDG PET/CT in oesophageal cancer is set to expand to include initial staging, assessment of disease response, therapy planning, and detection of disease recurrence. This article reviews the utility of FDG PET/CT in the management of oesophageal carcinoma, discussing its role and limitations in the imaging of these patients.

Dysphagia is a significant red flag symptom that always warrants urgent investigation. Although the majority of causes are benign, an underlying malignancy needs to be excluded. The mainstay of investigation of dysphagia involves flexible endoscopy. Direct visualization should not be delayed by other imaging, although caution should be adopted in view of the small but significant risks of the procedure. Further imaging can then be used to further clarify or stage an identified tumour. If a malignancy has been excluded, other investigations can be used to identify causes such as benign strictures or motility disorders.

The aim of this study was to assess the ability of artificial neural network (ANN) in predicting survival in patients undergoing surgical resection for carcinoma of oesophagus and oesophago-gastric junction.From January 1995 to August 2004 patients who underwent surgery for oesophageal and gastric carcinoma were identified. Biographical data, body mass index and pathological minimal cancer dataset were used to design an ANN. Post-operative survival was assessed at 1 and 3 years. Sixty percent of data was used to train and validate the ANN and 40% was used to evaluate the accuracy of trained ANN in predicting survival. This was compared with Union Internacional Contra la Cancrum UICC TNM classification system.Two hundred and sixteen patients underwent resectional surgery for oesophageal and OGJ carcinoma. The accuracy of the ANN in predicting survival at 1 and 3 years was 88% (sensitivity: 92.3%, specificity: 84.5%, DP = 2.3) and 91.5% (sensitivity of 94.61%, specificity: 88%, DP = 2.72), respectively. These figures were significantly better than 1- and 3-year survival predictions using the UICC TNM classification system 71.6% (sensitivity of 66.4%, specificity: 75.5%, and DP1) and 74.7% (sensitivity of 70.5%, specificity: 74.9%, DP1), respectively (P0.01) (P0.05).ANNs are superior to the UICC TNM classification system in correlating with survival following resection of carcinoma of oesophagus and OG junction and can become valuable tools in the management of patients with oesophageal carcinoma.

Objectives Assessment of morphological characteristics of lymphnodes studied ex-corpore by echoendoscopy—shape, sharpness of limits, echogenicity and dimensions—to categorize them either as metastatic or non-metastatic. Material and methods Fifty-four lymphnodes were studied. They were identified and studied by echoendoscopy in fresh surgical specimens of oesophagus, stomach and rectum. Eight nodal characteristics were evaluated. The data obtained were studied by multivariate analysis using the logistical estimate method in two different statistical models. Results In model 1, logistical estimate demonstrated that well-defined limits (WDL) of the lymphnodes and the association of hypoechogenicity and round shape were the most significant variables suggesting the presence of invasion. In model 2, the most significant variables were WDL, round shape and association of round shape with WDL. The first model had a high sensitivity of 93.1% and specificity of 68% whereas the second model had a greater specificity of 84%, with a slight fall in sensitivity. Conclusion These models might have an application to clinical practice particularly in the pre-operative assessment of patients with oesophageal carcinoma, gastric carcinoma or rectal carcinoma.

Over the last few decades the there has been a huge increase in the incidence of oesophageal adenocarcinoma, surpassing that of any other solid tumour. Barrett's oesophagus is recognised as a pre-malignant cursor. Surveillance programmes have evolved to monitor Barrett's oesophagus, with the intention to detect early malignant transformation. Using photosensitive agents photodiagnosis is developing to detect this transformation before it is visible endoscopically to allow early treatment. Photodynamic therapy is a non-thermal endoscopic ablative technique, which incorporates the same photosensitive agents to treat Barrett's oesophagus as well as malignant disease. In this article we review the present status of photodiagnosis and photodynamic therapy in the management of Barrett's oesophagus and early oesophageal carcinoma.

Aims. Positive microscopic margins after major cancer surgery adversely affect prognosis. We questioned whether the benefit of a multimodal approach in oesophageal carcinoma is due to reduced resection margin involvement and whether multimodal therapy alters the disease course when margins are involved. Methods. Pathology specimens of 212 patients, treated with either multimodal therapy or surgery alone, were re-reviewed to assess margin involvement by tumour. Margin status was compared with recurrence and survival data. Results. Margin involvement was decreased with multimodal therapy (16 of 103 patients) vs surgery (33 of 109 patients), associated with reduced tumour recurrence and a significant survival advantage. However, even with involved margins, multimodal therapy had lower recurrence vs surgery and a small survival benefit. Conclusions. Multimodal therapy significantly reduces margin involvement. The benefit of multimodal therapy remains highly significant for patients with clear margins. This study confirms for oesophageal carcinoma the value of an aggressive surgical approach in achieving negative resection margins.

Resume La curietherapie endo-œsophagienne s’est developpee avec l’emergence de la curietherapie de haut debit de dose (CHDD). La CHDD permet de traiter de facon exclusive les lesions in situ, elle permet une escalade de dose dans le traitement curateur des cancers de l’œsophage accessibles a l’association radiotherapie externe–curietherapie ou radiotherapie–chimiotherapie concomitante–curietherapie de complement. L’ensemble des series de la litterature, ainsi que la notre, confirment l’amelioration du controle local, mais cette amelioration n’a pas toujours une traduction en termes de survie. L’utilisation de la curietherapie doit repondre a une technique rigoureuse pour limiter le taux de complications.

The prognosis of oesophageal cancer patients is related to the portion of MIB-1 positively stained tumour nuclei. In this study, an image analysis system was developed based on LEICA Image Processing and Analysis System to reduce the subjective, tedious and inaccurate manual counting of nuclei staining. Representative oesophageal cancer tissues were collected and immunohistochemical preparations of MIB-1 were made. The MIB-1 positive nuclei in these tumours were assessed by quantitative counting, semi-quantitative counting, and three computer assessment methods using LEICA QWIN PRO. Our results showed that computer assessment methods were reliable and consistent. The procedure using the system could be accomplished within 15 min. Overlapped or missed counting of nuclei by the observer were eliminated. The image analysis system can really assist experts in obtaining reliable data for the prognosis of oesophageal cancer patients quickly.

Acquired oesophago-respiratory fistulae are a well-known complication of oesophageal carcinoma. Most of these are either oesophago-tracheal or oesophago-bronchial fistulae. However, oesophago-pulmonary fistulae have also been rarely reported. We present a case of oesophago-pulmonary fistula secondary to oesophageal carcinoma where the diagnosis was made by multidetector computed tomography (MDCT) with the assistance of three-dimensional (3D) imaging reconstruction.

Aims: The relationship between the pre-operative nutritional condition and the outcome of the surgical treatment in patients with oesophageal carcinoma has been discussed diversely. The aim of the current study was to demonstrate the relationship between pre-operative nutritional condition and post-operative complications and prognosis following surgical treatment for oesophageal carcinoma. Methods: Two hundred and fifty-eight patients with oesophageal carcinoma treated with oesophageal resection and reconstruction were selected. The correlation of pre-operative values of prognostic nutritional index (PNI) with the incidence of post-operative complications and prognosis of the patients was investigated. Results: The mean pre-operative value of PNI in patients with post-operative complications (41.8±5.4) was significantly lower than that in patients without post-operative complications (46.5±5.3;P

Background and purpose : To investigate the potential of intensity-modulated radiotherapy (IMRT) to reduce lung irradiation in the treatment of oesophageal carcinoma with radical radiotherapy. Materials and methods : A treatment planning study was performed to compare two-phase conformal radiotherapy (CFRT) with IMRT in five patients. The CFRT plans consisted of anterior, posterior and bilateral posterior oblique fields, while the IMRT plans consisted of either nine equispaced fields (9F), or four fields (4F) with orientations equal to the CFRT plans. IMRT plans with seven, five or three equispaced fields were also investigated in one patient. Treatment plans were compared using dose–volume histograms and normal tissue complication probabilities. Results : The 9F IMRT plan was unable to improve on the homogeneity of dose to the planning target volume (PTV), compared with the CFRT plan (dose range, 16.9±4.5 (1 SD) vs. 12.4±3.9%; P =0.06). Similarly, the 9F IMRT plan was unable to reduce the mean lung dose (11.7±3.2 vs. 11.0±2.9 Gy; P =0.2). Similar results were obtained for seven, five and three equispaced fields in the single patient studied. The 4F IMRT plan provided comparable PTV dose homogeneity with the CFRT plan (11.8±3.3 vs. 12.4±3.9%; P =0.6), with reduced mean lung dose (9.5±2.3 vs 11.0±2.9 Gy; P =0.001). Conclusions : IMRT using nine equispaced fields provided no improvement over CFRT. This was because the larger number of fields in the IMRT plan distributed a low dose over the entire lung. In contrast, IMRT using four fields equal to the CFRT fields offered an improvement in lung sparing. Thus, IMRT with a few carefully chosen field directions may lead to a modest reduction in pneumonitis, or allow tumour dose escalation within the currently accepted lung toxicity.

We report the case of a 56-year-old man who presented a section of a chest drain into the pleural cavity. Following an oesogastrectomy with coloplasty for oesophageal carcinoma, the patient developed a pleural effusion. During the implementation of pleural drainage, the intrathoracic drain tip was sectioned. The patient underwent a thoracotomy to remove the foreign body. The drain was probably cut during device removal through the particularly cutting trocar. This observation strengthens the need to refrain from withdrawing the movement tube through a Monod trocar.

Traditionally, surgery is considered to be the best treatment for oesophageal cancer (OC) for locoregional control and long-term survival. Since the survival rates are around 25% at 5 years after surgery alone, a multidisciplinary approach that includes surgery, radiotherapy (RT) and chemotherapy (CT), alone or in combination, may be necessary. The place of each of these treatments, depending on the disease stage, is under intensive research to define optimal therapeutic strategies.

A 60-year-old man presented an oesophageal transmural necrosis fistulised in the trachea following curative photodynamic therapy (PDT) for a superficial recurrence of an oesophageal carcinoma, initially treated by radiochemotherapy. Two stents, a tracheal and an oesophageal one, were placed. Eight months later the patient is in complete remission with only mild swallowing problems. This complication, although unusual, has already been described by other teams with the association of radiochemotherapy and PDT. The present case study suggests that illumination dose should be lowered in this indication.

Summary We have considerable experience in the use of both ALA and Photofrin-induced photodynamic therapy in the treatment of Barrett's oesophagus (with and without dysplasia) and both early and advanced oesophageal carcinoma. The drugs used and the techniques vary depending on the condition being treated. The techniques and doses used for the various conditions are outlined here.

The long-term results of patients with oesophageal carcinoma treated with pre-operative hyperthermo-chemo-radiotherapy (HCR) and pre-operative radiation therapy alone were compared. Twenty-six patients treated with pre-operative hyperthermo-chemo-radiotherapy (HCR Group) and 25 treated with radiation therapy alone (R Group), which demonstrated histopathologically marked effective results (Grade 3), were entered into the study. The 3-year survival rates after oesophagectomy in the HCR Group and the R Group were 67.4% and 41.8%, respectively, while the 5-year survival rates were 50.5% and 34.9%, respectively. Thus post-operative prognosis in the HCR Group was significantly more favourable than that in the R Group (P0.05). The local recurrence and distant metastasis rate in the HCR Group was significantly less than in the R Group (P0.01). This significant difference in prognosis was thought to be due to the reinforced effects of local regulation by hyperthermia and the systemic control of micrometastasis by chemotherapy in addition to radiation. Our data suggest that for carcinoma of oesophagus, pre-operative hyperthermo-chemo-radiotherapy contributes to prolonged post-operative survival while reducing both local recurrence and micrometastasis.

Three hundred and seventy-nine patients were studied retrospectively regarding the possibility of a complete resection of the oesophageal carcinoma based on the combined findings of pre-operative oesophagogoraphy and computed tomography (CT). One hundred and four out of 129 patients (96.1%) having lesions which did not demonstrate all three of the aforementioned factors (a lesion shorter than 8 cm, a normal oesophageal axis, and normal contact of the lesion with neighboring organs in CT) underwent a complete resection of the oesophageal lesion. Fifty-three percent of the patients ( 52 97 ) with a lesion showing only one of these factors had a complete resection. Whereas, on the other hand, a complete removal of the malignancy was only possible in 22% of the patients with two or all three of the findings. Moreover, as a result of further analysis limited for resected cases, the number of positive factors in these pre-operative findings correlated with the advancement of the surgical stage, which reflected a curability in surgery and a rate of postoperative complications. In order to make adequate plans for the treatment of patients with advanced oesophageal cancer, the finding of (i) the length of lesion, (ii) a deep ulceration and deformity of the oesophageal axis and (iii) any abnormal contact in CT, are considered to be very useful.

The extent and number of metastatic lymph nodes in 52 patients with oesophageal carcinoma involving more than one lymph node were analysed to determine the efficacy of lymphadenectomy. The patients were divided into two groups according to the number of metastatic lymph nodes, group A: 1–4 nodes (34 cases) and group B: 5 or more nodes (18 cases). The survival of all patients in group A was statistically better than that of the patients in group B ( P = 0.02). In cases where metastatic nodes were restricted to one region, the survival of patients in group A was significantly better than that of patients in group B ( P = 0.006). By contrast, in cases where metastatic nodes extended to two or more regions, there was no difference between the groups. The present study suggests that lymphadenectomy is effective only for patients with 1–4 metastatic nodes that are restricted to a single region. Lymphadenectomy is less efficacious in cases with five or more metastatic nodes, even when the nodes are restricted to one region, and is similarly ineffective in cases with metastatic nodes extending to two or more regions, regardless of the number of positive nodes.

The role of DNA ploidy in the management of oesophageal carcinoma is unclear. Most studies have employed flow cytometry (FC) for DNA analysis but some have used image analysis (IA) of tissue sections. In this study aneuploidy rates in stage IIa squamous tumours were determined by both FC and IA of cell suspensions and results were compared with outcome in two patient subgroups. Group 1 (n = 15) were patients who died from tumour recurrence within 1 year of surgery while Group 2 (n = 21) were patients who survived tumour free for at least 1 year. Aneuploidy rates differed significantly between techniques; 29 of 36 tumours (81%) were aneuploid by IA compared with 19 of 34 (56%) by FC (P0.05). Aneuploidy rates differed significantly between groups 1 and 2 as determined by FC (79%) versus 40%) (P0.05) but not by IA (93% versus 71%) (P = ns). Euploid status was a good prognostic indicator; 6 of 7 (86%) patients with euploid tumours by IA and 12 of 15 (80%) by FC (P0.05) survived more than 1 year. The sensitivity and specificity of euploidy was 93% and 28.6% for IA compared with 78.6% and 60% for FC. Since 33 (92%) of these tumours exhibited a marked peritumoral desmoplastic or chronic inflammatory reaction IA, being more sensitive to subtle nuclear change, may be a more appropriate technique than FC for evaluation of the role of ploidy in such tumours.

Detailed cytophotometric analyses of cell nuclear DNA content were performed on 132 different areas from 24 oesophageal squamous cell carcinomas with an intraepithelial component. Measurements of DNA content were performed at the three different areas within each of the intraepithelial and invasive components. There were no differences in the overall incidence of DNA distribution patterns which were classified according to the degree of dispersion and the peak value on the DNA histogram between intraepithelial and invasive components, as well as the average of mean values of the DNA content. In 13 (54%) of 24 cases, there was a variation among the DNA distribution patterns obtained from three different areas of the intraepithelial components, whereas there was a variation in 4 (22%) of the 18 invasive components. In 11 of 13 intraepithelial components with a variation, the same DNA distribution pattern as seen in the invasive component was present. Provided that the DNA content remains stable, variations in intraepithelial components may reflect various tumour cell populations. These findings support the idea of a multicentric carcinogenesis of oesophageal carcinoma, and shed light on the mechanisms in which a single cell population is selected from various cell populations in the progression from an intraepithelial to an invasive lesion.

Summary Osseous metastases from carcinoma of the oesophagus are rare. Metastases to the calcaneum are even rarer. We add another case to that which has already been reported in the literature.

Resection remains an important part of treating oesophageal carcinoma. The type of operation may not be as important as selecting the correct patient. Long-term survival will improve when systemic treatment is combined with surgery.

Background Synoptic reporting of specimens of resected oesophageal carcinoma was introduced by the department of anatomical pathology at Royal North Shore Hospital (RNSH) in August 2007. Although synoptic reporting is widely regarded as resulting in better reporting quality, there is little hard evidence for this widespread belief. Aim The purpose of this study was to ascertain whether synoptic reporting of resected oesophageal carcinoma specimens resulted in better reporting of pertinent data for a single institution via the introduction of a minimum data set, compared with traditional free-text reporting. Methods 27 synoptic reports and 42 free-text reports from RNSH were compared. Results Tumour size was reported microscopically or macro-scopically in all synoptic reports and 38 (90.5%) free-text reports. Invasion depth was reported in all free-text reports and in 26 (96.3%) synoptic reports. Pathological stage was reported in only 4 (9.5%) free-text reports, compared to all synoptic reports. However, stage could be determined from all reports. Grade was reported in all synoptic reports, but not in 3 (7.1%) free text-reports. Surgical resection margins were reported at higher rates in the synoptic reports (in particular radial/circumferential margin), as were measurements of tumour to resection margins. Small vessel and perineural invasion were reported in all synoptic reports, but only 36 (85.7%) and 31 (73.8%) free-text reports, respectively. Degree of regression post-preoperative chemoradiation was reported in 25 (92.6%) synoptic reports, but only 8 (19%) free-text reports. Conclusion The introduction of synoptic reporting at RNSH has resulted in increased information being contained in surgical pathology reports.

Lys751Gln and nasopharyngeal carcinoma risk until now. The frequency of the XRCC1 codon 280 homozygous wild-type Arg/Arg genotype was 77.9% (88/113) in cases and 80.8% (105/130) in controls; the heterozygous Arg/His genotype was 21.3% (24/113) in cases and 18.5% (24/130) in controls; and the His/His genotype was 0.8% (1/113) in cases and 0.7% (1/130) in controls. For XRCC1 codon 280 polymorphisms, no significant association between Arg280His and risk of NPC was found (OR 1.30, 95% CI 0.66–2.57; p = 0.447). Interpretation: Risk of NPC was nearly two and a half times higher for individuals with the homozygous wild-type Lys/Lys genotype than for the heterozygous Lys/Gln genotype, adjusted for age, sex, and ethnicity. To our knowledge, there have been no documented reports of the association between XPDLys751Gln and nasopharyngeal carcinoma risk until now. Funding: Science Fund, Ministry of Science and Innovation, Malaysia. The authors declared no conflicts of interest.