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Mediastinal lymph node recurrence is often observed following esophageal cancer surgery; however, no treatment has been established for the same. Surgical resection is often considered for cases of recurrence in a single lymph node region, although the procedures and approaches vary depending on the recurrence site. Right thoracoscopic resection is rarely opted for owing to its high surgical difficulty. Herein, we report a successful case of right thoracoscopic resection in the supine position for recurrent pretracheal lymph nodes following esophagectomy. The intraoperative findings revealed few adhesions around the recurrent lymph nodes due to the initial surgery, and the recurrent lymph nodes were safely resected within a short period. The patient was discharged on postoperative day 4 without any complications, and there was no recurrence after 20 months. Thus, right thoracoscopic resection may be a promising treatment option for recurrent pretracheal lymph nodes after esophagectomy. [ABSTRACT FROM AUTHOR]

Microsatellite instability (MSI) is categorized by mutation frequency: high MSI (MSI‐H), low MSI (MSI‐L) and microsatellite stable (MSS). MSI‐H tumors have a distinct immunogenic phenotype, with immunotherapies using checkpoint inhibitors already approved for the treatment of MSI‐H gastroesophageal adenocarcinoma (GEA); this is not observed for MSI‐L or MSS. Here, we tested the hypothesis that MSI‐L tumors are also a distinct phenotype and potentially immunogenic. MSI‐PCR assays (BAT25, BAT26, BAT40, D2S123, D5S346 and D17S250) were performed on 363 Epstein‐Barr virus‐negative, surgically resected esophagogastric junction (EGJ) adenocarcinoma samples. Tumors were characterized as MSI‐H (≥2 markers), MSI‐L (1 marker) or MSS (0 markers). CD8+ cell counts, PD‐L1 and HER2 expression levels, TP53 mutations, epigenetic alterations and prognostic significance were also examined. All pathological and molecular experiments were conducted using serial, whole‐tumor sections of chemo‐naïve surgical specimens. MSI‐H and MSI‐L were assigned to 28 (7.7%) and 24 (6.6%) cases, respectively. Compared to MSS cases, MSI‐L cases had significantly higher intratumoral CD8+ cell infiltration (P =.048) and favorable EGJ cancer‐specific survival (multivariate hazard ratio = 0.35, 95% CI, 0.12‐0.82; P =.012). MSI‐L tumors were also significantly associated with TP53‐truncating mutations as compared to MSI‐H (P =.009) and MSS (P =.012) cases, and this trend was also observed in GEA data from The Cancer Genome Atlas (TCGA). Indel mutational burden among TCGA MSI‐L tumors was significantly higher than that of MSS tumors (P =.016). These results suggest that MSI‐L tumors may have a distinct tumor phenotype and be potentially immunogenic in EGJ adenocarcinoma. What's new? Gastroesophageal adenocarcinoma patients with high microsatellite instability tumors present with a distinct phenotype and good response to immunotherapy. However, little is known about the immunogenic phenotype of low microsatellite instability (MSI‐L) tumors. Here, the authors show that, compared to gastroesophageal adenocarcinoma microsatellite stable tumors, MSI‐L tumors have significantly higher indel mutational burden, higher levels of intratumoral CD8+ cell infiltration, and favorable outcomes. The findings suggest a distinct immunogenic phenotype for MSI‐L tumors and the potential to also treat this gastroesophageal adenocarcinoma subtype by immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Neuroendocrine carcinoma (NEC) of the esophagus is a rare and highly aggressive disease but the biological features are poorly understood. The objective of this study was to analyze the clinicopathological and immunohistochemical features of NEC of the esophagus. Methods: Fourteen patients diagnosed with NEC of the esophagus from 1998 to 2013 were included in this study. Clinicopathologic features, therapeutic outcomes and immunohistochemical results were analyzed. Results: Eleven out of 14 cases showed protruding or localized type with or without ulceration. Only three patients were negative for both lymph node and organ metastasis and seven cases were positive for metastases to distant organs and/or distant lymph nodes. Of the six patients with limited disease (LD), three patients were treated by surgery. Three patients with LD and seven patients with extensive disease (ED) were initially treated with chemotherapy, except for one who underwent concurrent chemo-radiotherapy due to passage disturbance. The median survival of patients with LD was 8.5 months, whereas that of patients with LD was 17 months. Among the 14 cases, 12 cases (83.3%), 13 cases (91.7%) and 12 cases (83.3%) showed positive immunostaining for choromogranin A, synaptophysin and CD56, respectively. Nine of 14 cases (64.2%) presented positive staining for c-kit and most (8/9, 88%) simultaneously showed p53 protein abnormality. Two cases were negative for c-kit and p53, and positive for CK20. Conclusion: Consistent with previous reports, the prognosis of NEC of esophagus is dismal. From the results of immunohistochemical study, NEC of esophagus might be divided into two categories due to the staining positivity of c-kit and p53. This study provides new insight into the biology of NEC of the esophagus. [ABSTRACT FROM AUTHOR]