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Background In previous studies, three-dimensional funnel mesh devices have been used successfully for the repair of PSHs by combining a laparoscopic and ostomy-opening approach Methods We performed an analysis of prospectively collected data of patients who underwent a same-sided stoma reposition with 3D funnel-shaped mesh augmentation in intraperitoneal- onlay position at three departments between the years of 2012 and 2021. 56 patients received an implant with 2.5 cm funnel length and 25 patients with 4cm funnel length. Primary outcome parameters were surgical complications and recurrence rate. Results 81 patients could be included in this analysis. PSH repair was performed in 91% as elective surgery and in 87% in laparoscopic technique. A concomitant incisional hernia (EHS type 2 and 4) was found in 39% and repaired in a single-step procedure with PSH. Major postoperative complications requiring redo surgery were identified in 9.8% (8/81). Overall recurrence rate was 11% (9/81). Only 1 recurrence occurred in the group of 4 cm long implants (1/25= 4%). Median follow-up time was 44 months, and a 1-year follow-up rate of 91.4% was reached. Conclusion PSH repair with 3D funnel mesh in IPOM technique is safe, efficient and easy to perform providing advantageous results compared to other techniques. However the origin mesh funnel (2.5cm length) becomes shortened over time and further shrinkage happens eccentric concerning the flat mesh parts widening the funnel. Changing mesh construction according to consequently use the narrowest funnel (2cm) and it`s lengthening to 4cm led to reduction in recurrence without increasing implant-associated complications

Lateral abdominal wall hernias are rare and inconsistently defined, which is why the use of the EHS classification makes sense, not least for the purpose of comparing the quality of surgical results. A distinction must be made between true fascial defects and denervation atrophy. Based on the available literature, there is generally a low level of evidence with no consensus on the best operative strategy. The proximity to bony structures and the complex anatomy of the three-layer abdominal wall make lateral hernias difficult to care for. The surgical variability include laparo-endoscopic, robotic, minimally- invasive, open or hybrid approaches with different mesh positions in relation to the layers of the abdominal wall. The extensive preperitoneal mesh reinforcement open, transperitoneally laparoscopic (TAPP) or endoscopic extraperitoneally (TEP, TES) has met with the greatest approval. The extent of the required medial mesh- overlap is determined by the distance between the medial defect boundary and the lateral edge of the straight rectus-abdominal muscles. The lateral pre- and retroperitoneal dissection can be extended into the homolateral retrorectus compartment by laterally incising the posterior rectus sheath or can even be expanded by crossing the midline behind the intact linea alba into the contralateral retrorectus compartment. The “intraperitoneal onlay meshplasty” (IPOM) is only a suitable procedure for smaller and closable defects, but it is also important as an “exit strategy” in the case of a defective peritoneum. All procedures are explained using clear illustrations which are protected by copyright and were exclusively published in German in “der Chirurg”.

There are many good reasons for accreditation in pathology or neuropathology as per DIN EN ISO/IEC 17020, regardless of the size and range of services of the facility. Only accreditation - in contrast to certification - also confirms professional competence. This article describes how to establish a quality management system that conforms to standards as effectively as possible and how to maintain it, involve staff, and avoid common pitfalls. Adequate resources and active management support are essential. In this way, not only can accreditation succeed, but the facility itself and its employees can benefit from quality management in their daily work.Für eine Akkreditierung nach DIN EN ISO/IEC 17020 gibt es in der Pathologie oder Neuropathologie viele gute Gründe, unabhängig von der Größe und vom Leistungsspektrum der Einrichtung. Nur mit der Akkreditierung wird – im Unterschied zur Zertifizierung – auch die fachliche Kompetenz bestätigt. Der Artikel beschreibt, wie man ein normkonformes Qualitätsmanagementsystem möglichst effektiv aufbauen kann, wie man es aufrechterhält, die Mitarbeitenden beteiligt und häufige Pitfalls vermeidet. Dabei sind ausreichende Ressourcen und eine aktive Unterstützung der Leitung unverzichtbar. So gelingt nicht nur die Akkreditierung, sondern auch die Einrichtung selbst und ihre Mitarbeitenden profitieren in der täglichen Arbeit vom Qualitätsmanagement.

Bei einem 36-jahrigen Patienten wurde eine allogene Nierentransplantation durchgefuhrt (Match 1‑1‑0, Zytomegalievirus [CMV] Donor [D] +/Empfanger −, hohes Risiko). Elf Jahre zuvor war es zu einer Dialysepflichtigkeit im Rahmen einer bioptisch gesicherten tubulointerstitiellen Nephritis gekommen. Nach Transplantation ereignete sich im Verlauf des initialen stationaren Aufenthalts ein sukzessiver Hamoglobinabfall von 11,4 g/dl auf 7,3 g/dl. Initial war dies erklart durch die stattgehabte Nierentransplantation und einer chronisch fibrosierende Antrumgastritis mit Erosionen. Trotz wiederholter Transfusion von Erythrozytenkonzentraten bestand eine refraktare Anamie, weswegen sich der Patient mehrfach in unserer Klinik zur weiteren Diagnostik und Therapie vorstellte. Bei Darstellung von Riesenproerythroblasten im Knochenmark sowie dem quantitativen Nachweis von Parvovirus B19 (>900 Mio. IU/ml DNA-Replikationen) imponierte das Bild einer virusassoziierten Aplasie der Erythropoese. Eine intravenose Immunglobulinapplikation wurde etabliert und zeigte einen langfristigen therapeutischen Erfolg.

ZusammenfassungEine Verumontanum-Mukosahyperplasie (VMGH) ist eine benigne mikroazinäre proliferative Läsion, die ausschließlich im Verumontanum und in der posterioren Urethra auftritt und die zu den pseudoneoplastischen Imitatoren eines „low risk“ azinären Adenokarzinoms der Prostata zählt. Wir präsentieren den Fall eines 72-jährigen Patienten, bei dem 5 Jahre nach radikaler Prostatektomie wegen Adenokarzinom der Prostata pT2c pN0 cM0 R0, Gleason-Score: 3 + 3 = 6 der bildmorphologische Verdacht eines PSA-negativen Lokalrezidivs 3 × 2 cm im ehemaligen Prostatabett erhoben wurde. Das klinische Bild in Zusammenhang mit der histologischen Diagnostik führten zur Diagnose einer VMGH. Die VMGH ist eine kaum bekannte Differenzialdiagnose zum Lokalrezidiv eines Prostatakarzinoms bei einem PSA im Nullbereich, deren klinisches Bild dargestellt werden soll.

Die hohe Inzidenz parastomaler Hernien (PSH) von bis zu 80 % bei endstandigen Stomatragern und die breite Palette an Beschwerden und Komplikationen mit hohen Raten an Notoperationen aufgrund von Inkarzerationen (ca. 15 %) beweisen die klinische Relevanz der PSH-Pravention bereits bei Stomaanlage bzw. die groszugigere Indikationsstellung zur elektiven Korrektur einer manifesten PSH. Ziel dieser Arbeit ist es, die verfugbare Evidenz zur PSH-Reparation und Pravention zusammenfassend zu bewerten. Eingeschnittene Netzimplantate in unterschiedlichen Schichten der Bauchwand (Sublay, Onlay und Keyhole) weisen in der Korrektur einer manifesten PSH keine guten Ergebnisse auf. Stomalateralisationen mit flachen Netzen (Sandwich und Sugarbaker) oder 3‑D-tunnelformige Implantate zur Abdeckung der Stomarandbereiche liefern bessere Resultate. Die PSH-Pravention mit Netzen lasst sich, basierend auf der verfugbaren Datenlage mit 10 randomisiert kontrollierten Studien, Metaanalysen, einem Cochrane-Review und den Leitlinien der Europaischen Herniengesellschaft (EHS), gesamt gesehen als effektiv bewerten, wobei jedoch auch einzelne Studien ohne Effektivitatsnachweis der PSH-Pravention mit Netz existieren. Die teilweise heterogene Datenlage durfte in der unterschiedlichen operativen Methodenwahl mit verschiedenen Netzimplantaten in verschiedenen Schichten der Bauchwand begrundet sein. Die perioperativen Komplikationen zeigten in allen verfugbaren Arbeiten unabhangig von der Art der Pravention und dem verwendeten Netzmaterial keine Erhohung im Vergleich mit den herkommlichen Stomaanlagen. Trotz der positiven Datenlage spielt die PSH-Pravention in der taglichen Praxis eine untergeordnete Rolle, was mit Unsicherheiten der geeigneten operativen Methodik, dem zeitlichen Mehraufwand am Ende einer anspruchsvollen Operation, der Aversion gegen Fremdmaterialeinbringung in den kontaminierten Situs und der fehlenden Remuneration praventiver operativer Leistungen zu tun hat. Um geeignete Techniken zur PSH-Pravention filtern zu konnen, wird es zielfuhrender sein, in Zukunft differente Methoden der PSH-Pravention komparativ zu untersuchen, als eine bestimmte Form der Pravention mit der herkommlichen Stomaanlage zu vergleichen.

The successful treatment of complex abdominal wall hernias requires individualized and if necessary interdisciplinary treatment concepts. Due to the high potential for abdominal and cardiopulmonary complications, specialized centers with a high level of expertise and experience should undertake the care of patients. Prehabilitation and optimization of hernia-specific risk factors and comorbidities play an essential role in the treatment algorithm. Preoperative conditioning prior to surgery can be crucial for success. Bariatric surgery for weight loss and administration of botulinum toxin A in the lateral abdominal wall for stretching the musculature to provide myofascial advancement and enlargement of the torso diameter are parts of such strategies. The preoperative progressive pneumoperitoneum has its justification in massive evisceration, facilitates repositioning of the viscera and helps the patient to slowly adapt to the postoperatively changed abdominal pressure conditions. From a surgical technical point of view, the following principle should apply: "mesh augmentation comes before defect bridging". This means preference should be given to a morphological functional restoration of the myofascicular abdominal wall compared to procedures that merely bridge abdominal wall defects based on meshing. The retromuscular preperitoneal mesh strengthening in the sense of a sublay technique is the gold standard. This can be extended to anterior or posterior component separation techniques in order to achieve a reduction of tension to the midline and/or to achieve enlargement of the space for mesh placement.

In den 1780er und 1790er Jahren setzt sich die transnationale, vor allem von Grosbritannien aus agierende Abolitionsbewegung medienwirksam fur die Abschaffung von Sklavenhandel und Sklaverei ein. Widerhall findet der Kampf gegen Versklavung und Sklavenhandel auch im deutschsprachigen Raum, wie sich an der Berichterstattung in den Journalen dieser Zeit, aber auch an der Verarbeitung des Themas fur die Buhne zeigt. Die transnationale und zeitgeschichtliche Bedeutung zeigt sich in der Art der Rezeption, die nicht nur Themen und Argumente der Debatte aufnimmt, sondern auch die Grauel der Versklavung zu dokumentieren sucht und dabei den appellativen Charakter der Abolitionsbewegung ubernimmt. Wahrend fur die Berichterstattung in den Journalen die Referenz auf die Zeitgeschichte genrebedingt Voraussetzung ist, steht den Theaterstucken dieser Zeit keine geeignete Form zur Darstellung von Zeitgeschichte zur Verfugung. Um Zeitgeschichte auf die Buhne zu bringen, mussen sie die zeitgenossischen Gattungsformen uberschreiten, und sie tun dies nicht zuletzt, indem sie Formen und Strategien der Journalberichterstattung ubernehmen.

In recent years techniques for ventral hernia repair have undergone a dynamic evolution with the development of minimally invasive and laparoendoscopic techniques. Despite the multitude of methods, five main criteria for setting the target have emerged: 1) functional and morphological reconstruction of the abdominal wall, 2) extraperitoneal mesh augmentation, 3) abandonment of penetrating fixation elements, 4) minimal surgical access trauma of the abdominal wall and 5) minimized intraperitoneal dissection that jeopardizes adherent intestinal structures. The mesh position varies between preperitoneal retromuscular and supraneurotic or preaponeurotic on the anterior rectus sheath. The different approaches can be carried out transhernially or distant from the abdominal wall defect. The latter can be realized by laparoscopic transperitoneal, endoscopic subcutaneous and endoscopic retromuscular/preperitoneal approaches. Some techniques can be extended to anterior or posterior component separation to reduce tension and to enlarge the space for mesh placement. Robot-assisted surgery opens up new perspectives in laparoendoscopic abdominal wall surgery due to additional instrumental degrees of movement. This enables the possibility of preperitoneal ventral hernia operations also behind and lateral to the posterior rectus muscle compartments as was only previously known below the arcuate line from inguinal hernia surgery.

An allogeneic kidney transplantation (match 1‑1‑0, cytomegalovirus, CMV, donor, D, +/recipient, R, - high risk) was performed in a 36-year-old patient. The patient was on dialysis due to a tubulointerstitial nephritis confirmed by biopsy 11 years previously. Posttransplantation there was a gradual decrease in the hemoglobin (Hb) level from 11.4 g/dl to 7.3 g/dl during the initial hospitalization period. Initially this was explained by the kidney transplantation and chronic fibrosing antral gastritis with erosions. Despite repeated transfusion of red cell concentrates, a refractory anemia persisted, which is why the patient presented several times at our clinic for further diagnosis and treatment. The presence of giant erythroblasts in the bone marrow and quantitative detection of parvovirus B19 (900 million IU/ml DNA replications) was consistent with a virus-associated red cell aplasia. Intravenous immunoglobulin administration was established and showed long-term therapeutic success.Bei einem 36-jährigen Patienten wurde eine allogene Nierentransplantation durchgeführt (Match 1‑1‑0, Zytomegalievirus [CMV] Donor [D] +/Empfänger −, hohes Risiko). Elf Jahre zuvor war es zu einer Dialysepflichtigkeit im Rahmen einer bioptisch gesicherten tubulointerstitiellen Nephritis gekommen. Nach Transplantation ereignete sich im Verlauf des initialen stationären Aufenthalts ein sukzessiver Hämoglobinabfall von 11,4 g/dl auf 7,3 g/dl. Initial war dies erklärt durch die stattgehabte Nierentransplantation und einer chronisch fibrosierende Antrumgastritis mit Erosionen. Trotz wiederholter Transfusion von Erythrozytenkonzentraten bestand eine refraktäre Anämie, weswegen sich der Patient mehrfach in unserer Klinik zur weiteren Diagnostik und Therapie vorstellte. Bei Darstellung von Riesenproerythroblasten im Knochenmark sowie dem quantitativen Nachweis von Parvovirus B19 (900 Mio. IU/ml DNA-Replikationen) imponierte das Bild einer virusassoziierten Aplasie der Erythropoese. Eine intravenöse Immunglobulinapplikation wurde etabliert und zeigte einen langfristigen therapeutischen Erfolg.

We investigate the effect of key audit matters (KAM) in the auditor’s report as required by the new ISA 701. We consider investment professionals and non-professional investors in our experiments, in which we test the communicative value of a KAM section relating to goodwill impairment. Our main results show that in the condition in which the KAM section suggests that already small changes in the key assumptions could eventually lead to a goodwill impairment (KAM negative condition), investment professionals assess the economic situation of the company to be significantly better as compared to the condition in which the KAM section suggests that only large changes in the key assumptions could eventually lead to a goodwill impairment (KAM positive condition). In the additional analysis with non-professional investors, we find that a KAM section has no communicative value, implying that non-professional investors have difficulties with processing the information conveyed with KAM.

Verumontanum mucosal gland hyperplasia (VMGH) is a benign microacinar proliferative lesion, which occurs exclusively in the verumontanum and the posterior urethra and is one of the lesions that may be confused with a low-risk adenocarcinoma of the prostate gland.We present the case of a 72-year-old male patient who underwent radical prostatectomy due to an adenocarcinoma of the prostate gland (pT2c pN0 cM0 R0, Gleason Score: 3 + 3 = 6). Five years after the operation, we sonographically detected a 3x2 cm large tumour in the prostate bed. While our first assumption was a PSA-negative local recurrence following radical prostatectomy, a comprehensive histological examination along with the clinical evaluation led us to the diagnosis of a VMGH. VMGH is a less well-known differential diagnosis of PSA-negative local recurrence following radical prostatectomy, whose clinical manifestation should be presented.Eine Verumontanum-Mukosahyperplasie (VMGH) ist eine benigne mikroazinäre proliferative Läsion, die ausschließlich im Verumontanum und in der posterioren Urethra auftritt und die zu den pseudoneoplastischen Imitatoren eines „low risk“ azinären Adenokarzinoms der Prostata zählt. Wir präsentieren den Fall eines 72-jährigen Patienten, bei dem 5 Jahre nach radikaler Prostatektomie wegen Adenokarzinom der Prostata pT2c pN0 cM0 R0, Gleason-Score: 3 + 3 = 6 der bildmorphologische Verdacht eines PSA-negativen Lokalrezidivs 3 × 2 cm im ehemaligen Prostatabett erhoben wurde. Das klinische Bild in Zusammenhang mit der histologischen Diagnostik führten zur Diagnose einer VMGH. Die VMGH ist eine kaum bekannte Differenzialdiagnose zum Lokalrezidiv eines Prostatakarzinoms bei einem PSA im Nullbereich, deren klinisches Bild dargestellt werden soll.

After formation of a permanent terminal stoma by enterostomy, parastomal hernia (PSH) occurs in up to 80% of cases and leads to a wide variety of symptoms and complications with a high rate of emergency operations due to incarceration (ca. 15%). Consequently, greater consideration should be given to PSH prevention even as early as the time of enterostomy and generously applied indications for elective repair of manifest PSH. The aim of this article is to summarize and evaluate the current evidence for PSH repair and prevention. Poor postoperative results after attempted repair of manifest PSH with slit meshes in different layers of the abdominal wall shift the focus onto stoma lateralization (sandwich and Sugarbaker techniques) or 3‑dimensional tunnel-shaped implants with meshes to cover the stomal edges. To date, the best strategy for PSH prevention has still not been defined and techniques with slit meshes show different results. Nevertheless, 10 prospective randomized trials, meta-analyses, a Cochrane review and guidelines from the European Hernia Society (EHS) about various slit-mesh devices in sublay, onlay and intraperitoneal positions confirmed significantly reduced rates of PSH after mesh augmentation compared to conventionally sutured enterostomy without morbidity associated with the implanted material. Despite the positive data situation PSH prevention is seldom performed in daily practice, which is due to uncertainty surrounding the most suitable surgical strategy, the necessity to spend additional time at the end of a demanding operation, the aversion to implanting meshes into a contaminated operative field and the lack of remuneration of preventive surgical procedures. Future trials should, therefore, no longer compare standard enterostomy techniques with one prevention method in general but should have a new focus on techniques providing adequate results in PSH repair (Sugarbaker, sandwich and 3‑D tunnel meshes), probe the advantages and evaluate the differences in outcome between these strategies.

The successful treatment of complex abdominal wall hernias requires individualized and if necessary interdisciplinary treatment concepts. Due to the high potential for abdominal and cardiopulmonary complications, specialized centers with a high level of expertise and experience should undertake the care of patients. Prehabilitation and optimization of hernia-specific risk factors and comorbidities play an essential role in the treatment algorithm. Preoperative conditioning prior to surgery can be crucial for success. Bariatric surgery for weight loss and administration of botulinum toxin A in the lateral abdominal wall for stretching the musculature to provide myofascial advancement and enlargement of the torso diameter are parts of such strategies. The preoperative progressive pneumoperitoneum has its justification in massive evisceration, facilitates repositioning of the viscera and helps the patient to slowly adapt to the postoperatively changed abdominal pressure conditions. From a surgical technical point of view, the following principle should apply: "mesh augmentation comes before defect bridging". This means preference should be given to a morphological functional restoration of the myofascicular abdominal wall compared to procedures that merely bridge abdominal wall defects based on meshing. The retromuscular preperitoneal mesh strengthening in the sense of a sublay technique is the gold standard. This can be extended to anterior or posterior component separation techniques in order to achieve a reduction of tension to the midline and/or to achieve enlargement of the space for mesh placement.

Perivascular epithelioid cell neoplasms (PEComas) are a family of mesenchymal neoplasms with features of both melanotic and smooth muscle differentiation. PEComa morphology is highly variable and encompasses epithelioid to spindle cells often with clear cytoplasm and prominent nucleoli. Molecularly, most PEComas are defined by a loss of function of the TSC1/TSC2 complex. Additionally, a distinct small subset of PEComas harboring rearrangements of the TFE3 (Xp11) gene locus has been identified. By presenting a series of three case reports with distinct features, we demonstrate diagnostic pitfalls as well as the importance of molecular work-up of PEComas because of important therapeutic consequences.

In recent years techniques for ventral hernia repair have undergone a dynamic evolution with the development of minimally invasive and laparoendoscopic techniques. Despite the multitude of methods, five main criteria for setting the target have emerged: 1) functional and morphological reconstruction of the abdominal wall, 2) extraperitoneal mesh augmentation, 3) abandonment of penetrating fixation elements, 4) minimal surgical access trauma of the abdominal wall and 5) minimized intraperitoneal dissection that jeopardizes adherent intestinal structures. The mesh position varies between preperitoneal retromuscular and supraneurotic or preaponeurotic on the anterior rectus sheath. The different approaches can be carried out transhernially or distant from the abdominal wall defect. The latter can be realized by laparoscopic transperitoneal, endoscopic subcutaneous and endoscopic retromuscular/preperitoneal approaches. Some techniques can be extended to anterior or posterior component separation to reduce tension and to enlarge the space for mesh placement. Robot-assisted surgery opens up new perspectives in laparoendoscopic abdominal wall surgery due to additional instrumental degrees of movement. This enables the possibility of preperitoneal ventral hernia operations also behind and lateral to the posterior rectus muscle compartments as was only previously known below the arcuate line from inguinal hernia surgery.

Open anterior release of the external oblique fascia to enable midline closure of large abdominal wall defects is associated with relevant morbidity due to extensive subcutaneous dissection. Using endoscopic techniques, wound complications can be minimized. However, identification of the correct entry point (e.g. for balloon trocar insertion) can be challenging especially in adipose patients. We therefore present a technical modification facilitating the entire procedure. A novel technique for endoscopic anterior component separation using a trocar system allowing blunt and sharp dissection under direct vision is described. This brief communication also contains our initial experience and learning curve with this novel approach. Endoscopic release of the external oblique fascia was successfully performed 29 times in a total of 15 patients. Body mass index accounted for 30.8 kg/m2 (median; range 21.6–42.5). Transverse width of midline defect accounted for 7 cm (median; range 4–12). Subsequent hernia repair was successfully done using sublay mesh reinforcement (n = 13) or a laparoscopic intraperitoneal onlay mesh procedure (n = 2) with midline closure in all cases. One hematoma was seen at site of release managed conservatively. Using a trocar system allowing blunt and sharp dissection under direct vision may be a viable option for the endoscopic anterior component separation.

Hintergrund Knochensarkome sind seltene Erkrankungen mit Haufigkeitsgipfeln im Kindes- und jungen Erwachsenenalter bzw. hoheren Erwachsenenalter.

Die morphologische Diagnose von Knochentumoren stellt oft eine Herausforderung dar. Molekularpathologisch sind bei der Routinediagnostik von Knochentumoren bisher zwei spezifische genetische Veranderungen von Bedeutung: zum einen die Detektion der EWSR1-Translokation bei Ewing-Sarkomen, zum anderen die GNAS1-Mutationsanalyse bei fibroser Dysplasie. Sensitivere und schnellere Techniken ermoglichen jedoch eine bessere Detektion von spezifischen genetischen Veranderungen bei Knochentumoren. So lassen sich bei vielen anderen Knochentumoren spezifische Translokationen und Mutationen feststellen, mit denen sich in Zukunft die Diagnose anhand des morphologischen Bilds durch den molekularpathologischen Nachweis dieser spezifischen genetischen Veranderung unterstutzen lasst. Manche Tumoren, wie z. B. das Osteosarkom, weisen jedoch eine generell hohe genetische Instabilitat mit zahlreichen, nichtspezifischen genetischen Veranderungen auf.

Despite multimodal therapeutic options, esophageal cancer is still among the most deadly malignancies. In the past decade, targeted therapy has shown great potential in other cancers, but data on esophageal carcinoma are still rare. Five potential new molecular targets in esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) were investigated for their expression characteristics: vascular endothelial growth factor receptor (VEGFR)-3, human epidermal growth factor receptor-2, stem cell growth factor receptor, tissue inhibitors of metalloproteinase (TIMP)-4 and TIMP-3. One hundred seventy-one EAC and ESCC tissue samples obtained from patients undergoing esophagectomy from 2000 to 2008 were included. Clinical data were evaluated retrospectively. Immunohistochemical staining was performed using tumor tissue with and without neoadjuvant treatment and healthy tissue. For samples without neoadjuvant treatment, expression of all targets was higher in tumor tissue than in healthy tissue except for VEGFR-3 (>98% expression in both tissues). For TIMP-4, TIMP-3 and stem cell growth factor receptor, trends to higher expression in tumor tissue were also found in EAC and ESCC that had received neoadjuvant treatment. Using Matched-pair analysis, we compared target expression in tumor tissue with and without neoadjuvant treatment. Only TIMP-3 had significantly lower expression in neoadjuvant treated tumor tissue (EAC: P = 0.059, ESCC: P = 0.006). TIMP-4, TIMP-3 and VEGFR-3 appear to qualify for targeted therapy in esophageal cancer because of their high expression in neoplastic tissue. TIMP-3 appears to be downregulated in neoadjuvantly treated esophageal cancer, and VEGFR-3 shows high expression in healthy mucosa leading to severe side effects by molecular targeting. Thus, TIMP-4 seems the most promising target.