Significance of palisading longitudinal esophagus vessels: identification of the true esophagogastric junction has histopathological and oncological considerations.

BACKGROUND

Identification of the true esophagogastric junction (EGJ) is essential for diagnosis of Barrett's esophagus.

AIMS

To determine whether the lower end of palisading longitudinal esophagus vessels (PLEV) is a novel and reliable marker for histological identification of the EGJ, and to investigate how short-segment Barrett's esophagus develops.

METHODS

Using 87 formalin-fixed esophagogastrectomy specimens of squamous cell carcinoma of upper or middle esophagus, the entire lower esophagus area including the putative EGJ was histologically examined. The EGJ was first determined on each longitudinal section by the most distal end of the esophageal glands proper, squamous islands, or multilayered epithelium. The most distal end of PLEV was identified thereafter. If this end was distal to the above markers, it was judged as the novel point of the EGJ. A circular reference line was set to the middle level of the angle of His. Distances from this line to the squamocolumnar junction (SCJ) or EGJ were measured.

RESULTS

The distances to the SCJ or EGJ on the lesser curvature side were significantly longer than those on the greater curvature side (P < 0.0001). The extent of Barrett's epithelium was significantly longer on the lesser curvature side than on the greater curvature side (P < 0.005). The SCJ line, the conventional EGJ line, and the EGJ line determined by conventional factors combined with the most distal end of PLEV were located proximal to distal, in that order (P < 0.0001).

CONCLUSIONS

The lower end of PLEV is a feasible histological marker of the EGJ.