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In this case report, a male patient in his 50′s presented with right-sided neck swelling for 2 months and an acute episode of hematochezia along with vague abdominal and systemic symptoms for 2-3 years. The clinical suspicion was gastric carcinoma.Fine needle aspiration cytology (FNAC) from the neck swelling was inconclusive, and upper gastrointestinal (GI) endoscopy was normal. However, contrast enhanced CT neck, chest, and abdomen revealed focal, heterogeneously enhancing wall thickening in the cardia of the stomach with periportal and perigastric nodes showing peripheral rim enhancement; ascites and peritoneal thickening; a cold abscess in the right axilla; cervical and mediastinal lymph nodes with central hypodensity; and tree-in-bud opacities with sub-segmental consolidation in the lower lobe of the left lung. A diagnosis of disseminated tuberculosis was made, and the patient was successfully treated with empirical antitubercular therapy.This case highlights an uncommon presentation of tuberculosis of gastric cardia and a need to have a high index of suspicion, even in the absence of positive microbiological confirmation of the disease.

Gastric cardia cancer is a high-incidence malignant tumour, which seriously endangers human health and life safety. The patient prognosis of gastric cardia cancer is affected by diet, physical condition, regional environment, medical history and other factors. Traditional prediction methods cannot fully reflect the prognosis characteristics and survival risks of all patients. Therefore, this paper proposes a data-driven method for the survival risk of cardiac cancer based on an adaptive particle swarm optimization algorithm (APSO) and a dynamic modular neural network (DMNN). First, the article uses density clustering to cluster 293 patients’ blood characteristics and generate different sub-networks. Second, the weight is calculated through the APSO algorithm and the sub-network output is obtained by the integration algorithm. At last, the effectiveness of this network is verified through a 50% cross-validation of training sets and test sets. The results show that the survival prediction based on the APSO-DMNN data-driven method shows good classification performance and accuracy.

BackgroundThe incidence pattern of gastric cancer by histological types across major race/ethnic groups is unknown.MethodsAge-standardized rates from 1992-2016 by race/ethnicity were calculated using data from Surveillance, Epidemiology, and End Results Program (SEER). Annual percent changes (APCs) in rates and corresponding 95% confidence intervals (CIs) were calculated and pairwise comparison of rates between race/ethnic groups was performed using the Joinpoint Regression Program. Calendar periods of incidence rates of gastric cardia and non-cardia cancer by histological types across race/ethnicity groups were shown by figures.ResultsThe White population has the highest incidence of gastric cardia adenocarcinoma and the incidence is keeping constant from 1992 through 2016 except the decreasing in the Asian population (AAPC = -1.4, 95%CI (-2.1, -0.8)). Although the incidence of non-cardia adenocarcinoma is decreasing in each group, the descending trend in the Asian population is the quickest (AAPC = -3.8, 95%CI (-4.0, -3.5)). Gastric carcinoids were observed to have statistically significant increasing trends in all race/ethnicity groups, especially in Hispanic women from 0.4 per 100,000 to 1.6 per 100,000 persons. The incidence of gastrointestinal stromal tumors (GISTs) is rising, with Non-Hispanic blacks having the highest incidence.ConclusionThis study demonstrated disparities in the incidence of gastric cancer by histological types among different race/ethnic groups. Further investigations are warranted to understand the changing incidence patterns by race/ethnicity.

Background: Intestinal metaplasia (IM) of the gastric cardia is an important premalignant lesion. However, there is limited information concerning its epidemiological and molecular features. Herein, we aimed to provide an overview of the epidemiological data for gastric cardiac IM and evaluate the role of EYA transcriptional coactivator and phosphatase 4 (EYA4) as an epigenetic biomarker for gastric cardiac IM. Methods: The study was conducted in the context of the gastric cardiac precancerous lesion program in southern China, which included 718 non-cancer participants, who undertook endoscopic biopsy and pathological examination in three endoscopy centers, between November 2018 and November 2021. Pyrosequencing and immunohistochemistry were performed to examine the DNA methylation status and protein expression level of EYA4. Results: Gastric cardiac IM presented in 14.1% (101/718) of participants and was more common among older (>50 years; 22.0% [95% CI: 17.8–26.8]) than younger participants (≤50 years; 6.7% [95% CI: 4.5–9.9]; P < 0.001). IM was more common in male participants (16.9% [95% CI: 13.2–21.3] vs. 11.3% [95% CI: 8.3–15.1]; P = 0.04). Pyrosequencing revealed that IM tissues exhibited significantly higher DNA methylation levels in EYA4 gene than normal tissues (P = 0.016). Further, the protein expression level of EYA4 was reduced in IM and absent in intraepithelial neoplasia tissues compared to normal tissues (P < 0.001). Conclusions: Detection rates of gastric cardiac IM increase with age and are higher in men. Our findings highlight the important role of promoter hypermethylation and downregulation of EYA4 in gastric cardiac IM development.

Background: Intestinal metaplasia (IM) of the gastric cardia is an important premalignant lesion. However, there is limited information concerning its epidemiological and molecular features. Herein, we aimed to provide an overview of the epidemiological data for gastric cardiac IM and evaluate the role of EYA transcriptional coactivator and phosphatase 4 (EYA4) as an epigenetic biomarker for gastric cardiac IM. Methods: The study was conducted in the context of the gastric cardiac precancerous lesion program in southern China, which included 718 non-cancer participants, who undertook endoscopic biopsy and pathological examination in three endoscopy centers, between November 2018 and November 2021. Pyrosequencing and immunohistochemistry were performed to examine the DNA methylation status and protein expression level of EYA4. Results: Gastric cardiac IM presented in 14.1% (101/718) of participants and was more common among older (>50 years; 22.0% [95% CI: 17.8–26.8]) than younger participants (≤50 years; 6.7% [95% CI: 4.5–9.9]; P < 0.001). IM was more common in male participants (16.9% [95% CI: 13.2–21.3] vs. 11.3% [95% CI: 8.3–15.1]; P = 0.04). Pyrosequencing revealed that IM tissues exhibited significantly higher DNA methylation levels in EYA4 gene than normal tissues (P = 0.016). Further, the protein expression level of EYA4 was reduced in IM and absent in intraepithelial neoplasia tissues compared to normal tissues (P < 0.001). Conclusions: Detection rates of gastric cardiac IM increase with age and are higher in men. Our findings highlight the important role of promoter hypermethylation and downregulation of EYA4 in gastric cardiac IM development. [ABSTRACT FROM AUTHOR]

In this case report, a male patient in his 50's presented with right-sided neck swelling for 2 months and an acute episode of hematochezia along with vague abdominal and systemic symptoms for 2-3 years. The clinical suspicion was gastric carcinoma. Fine needle aspiration cytology (FNAC) from the neck swelling was inconclusive, and upper gastrointestinal (GI) endoscopy was normal. However, contrast enhanced CT neck, chest, and abdomen revealed focal, heterogeneously enhancing wall thickening in the cardia of the stomach with periportal and perigastric nodes showing peripheral rim enhancement; ascites and peritoneal thickening; a cold abscess in the right axilla; cervical and mediastinal lymph nodes with central hypodensity; and tree-in-bud opacities with sub-segmental consolidation in the lower lobe of the left lung. A diagnosis of disseminated tuberculosis was made, and the patient was successfully treated with empirical antitubercular therapy. This case highlights an uncommon presentation of tuberculosis of gastric cardia and a need to have a high index of suspicion, even in the absence of positive microbiological confirmation of the disease., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

ABSTRACT The objective of this study was to describe and compare the dynamic microbiota characteristics in the gastrointestinal (GI) tract in Chinese participants via high-throughput sequencing techniques. The study collected saliva, esophageal swab, cardia biopsy, noncardia biopsy, gastric juice, and fecal specimens from 40 participants who underwent upper GI tract cancer screening in Linzhou (Henan, China) in August 2019. The V4 region of 16S rRNA genes was amplified and sequenced using the Illumina MiniSeq platform. The observed amplicon sequence variants (ASVs) gradually decreased from saliva to esophageal swab, cardia biopsy, noncardia biopsy, and gastric juice specimens and then increased from gastric juice to fecal specimens (P

Abstract Background Measuring the DNA methylome may offer the opportunity to identify novel disease biomarkers and insights into disease mechanisms. Although aberrant DNA methylation has been investigated in many human cancers and precancerous lesions, the DNA methylation landscape of gastric cardiac intestinal metaplasia (IM) remains unknown. Therefore, we aimed to investigate the genome-wide DNA methylation landscape and to search for potential epigenetic biomarkers of gastric cardiac IM. Methods Histopathologic profiling was performed on a total of 118 gastric cardiac biopsies from cancer-free individuals. Genome-wide DNA methylation analysis was performed on 11 gastric cardiac mucosal biopsies (IM = 7; normal = 4) using Illumina 850K microarrays. Transcriptional relevance of any candidate epigenetic biomarker was validated by qRT-PCR. Results The detection rate of gastric cardiac IM was 23% (27/118) in cancer-free individuals. Genome-wide DNA methylation profiling showed a global decrease in methylation in IM compared with normal tissues (median methylation = 0.64 and 0.70 for gastric cardiac IM and normal tissues, respectively). Differential methylation analysis between gastric cardiac IM and normal tissues identified 38,237 differentially methylated probes (DMPs) with a majority of sites showing hypermethylation in IM compared with normal tissues (56.3% vs. 43.7%). Subsequent analysis revealed a significant enrichment of hypermethylated DMPs in promoter and CpG islands (p

Carcinosarcoma is a rare malignant neoplasm, consisting of both epithelial and mesenchymal component. Primary gastric carcinosarcoma is rare and poorly understood. We reported clinicopathologic features of 4 cases and analysis of 76 cases published in the literature. Clinical symptoms were nonspecific with epigastric pain, weight loss, and melena, as the most common complaints. The prognosis of patients was dismal with high mortality. The tumor commonly occurred in the upper stomach in Chinese patients, whereas, it was more prevalent at the lower stomach in Japanese and other populations. The two malignant components of this rare cancer showed considerable histological heterogeneity with a wide range of differentiation. We propose that carcinosarcomas be divided in two main subtypes: conventional carcinosarcoma and carcinosarcoma, not-otherwise-specified (NOS). Such distinction may provide useful information for targeted treatment of various sarcomatous components of this tumor. Immunohistochemistry should be routinely applied in the diagnosis of this rare tumor.

Background:Helicobacter pylori (H. pylori) is widely accepted to be the most important cause of gastric non-cardia adenocarcinoma (GNCA), while its role in the development of gastric cardia adenocarcinoma (GCA) is not well-defined. We aimed to investigate current H. pylori infection in relation to the severity of both precancerous and cancerous lesions of the gastric cardia in an Asian population at high risk of GCA.Methods: A population-based cross-sectional study was conducted in Linzhou County, Henan Province, China. Two thousand three (2,003) randomly selected participants with data on current H. pylori infection, assayed by 13C-urea breath test (13C-UBT), and a sequence of histological diagnoses of the gastric cardia mucosa were analyzed.Results: Of 2,003 subjects, 828 (41.33%) were currently infected with H. pylori. The prevalence of current H. pylori infection increased with increasing severity of histological lesions, from 34.12% in subjects with normal gastric cardia mucosa to 52.17% in subjects with gastric cardia high-grade intraepithelial neoplasia (CHIN)/ gastric cardia adenocarcinoma (GCA) (P for trend

Background: Measuring the DNA methylome may offer the opportunity to identify novel disease biomarkers and insights into disease mechanisms. Although aberrant DNA methylation has been investigated in many human cancers and precancerous lesions, the DNA methylation landscape of gastric cardiac intestinal metaplasia (IM) remains unknown. Therefore, we aimed to investigate the genome-wide DNA methylation landscape and to search for potential epigenetic biomarkers of gastric cardiac IM.Methods: Histopathologic profiling was performed on a total of 118 gastric cardiac biopsies from cancer-free individuals. Genome-wide DNA methylation analysis was performed on 11 gastric cardiac mucosal biopsies (IM = 7; normal = 4) using Illumina 850K microarrays. Transcriptional relevance of any candidate epigenetic biomarker was validated by qRT-PCR.Results: The detection rate of gastric cardiac IM was 23% (27/118) in cancer-free individuals. Genome-wide DNA methylation profiling showed a global decrease in methylation in IM compared with normal tissues (median methylation = 0.64 and 0.70 for gastric cardiac IM and normal tissues, respectively). Differential methylation analysis between gastric cardiac IM and normal tissues identified 38,237 differentially methylated probes (DMPs) with a majority of sites showing hypermethylation in IM compared with normal tissues (56.3% vs. 43.7%). Subsequent analysis revealed a significant enrichment of hypermethylated DMPs in promoter and CpG islands (p < 0.001 for both, Pearson χ2 test). For DMPs located in promoter CpG islands showing extreme hypermethylation, the candidate gene with the largest number of DMPs (n = 7) was mapped to HOXA5. Accordingly, mRNA expression of HOXA5 was significantly reduced in IM compared to normal tissue.Conclusions: Our results suggest the implication of alterations in DNA methylation in gastric cardiac IM and highlight that HOXA5 hypermethylation may be a promising epigenetic biomarker, emphasizing the role of aberrant HOXA5 expression in the pathogenesis of gastric cardiac IM. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori (H. pylori) is widely accepted to be the most important cause of gastric non-cardia adenocarcinoma (GNCA), while its role in the development of gastric cardia adenocarcinoma (GCA) is not well-defined. We aimed to investigate current H. pylori infection in relation to the severity of both precancerous and cancerous lesions of the gastric cardia in an Asian population at high risk of GCA. Methods: A population-based cross-sectional study was conducted in Linzhou County, Henan Province, China. Two thousand three (2,003) randomly selected participants with data on current H. pylori infection, assayed by 13C-urea breath test (13C-UBT), and a sequence of histological diagnoses of the gastric cardia mucosa were analyzed. Results: Of 2,003 subjects, 828 (41.33%) were currently infected with H. pylori. The prevalence of current H. pylori infection increased with increasing severity of histological lesions, from 34.12% in subjects with normal gastric cardia mucosa to 52.17% in subjects with gastric cardia high-grade intraepithelial neoplasia (CHIN)/ gastric cardia adenocarcinoma (GCA) (P for trend <0.001). With H. pylori -negative subjects as the reference category, H. pylori -positive subjects had statistically significant elevated adjusted prevalence odds ratios (PORs) for each of the histological lesions. The PORs (95% CI) were 2.15 (1.74–2.64), 3.46 (2.08–5.75), 2.78 (1.90–4.07), and 3.05 (1.30–7.17) for subjects with carditis, cardia intestinal metaplasia (CIM), cardia low-grade intraepithelial neoplasia (CLIN), and CHIN/GCA), respectively. The associations remained when subjects with abnormal stomach non-cardia mucosa were excluded. Conclusions: This large epidemiologic study demonstrates a positive association between current H. pylori infection and the severity of both precancerous and cancerous lesions of the gastric cardia in an Asian population at high risk of GCA. These findings suggest that H. pylori infection may play a role throughout both early- and late-stage development of GCA. [ABSTRACT FROM AUTHOR]

Background: Gastric subepithelial tumors (SETs) may harbor potential malignancy. Although it is well recognized that large SETs should be resected, the precise treatment strategy remains controversial. Compared to surgical resection, endoscopic resection (ER) has many advantages; however, ER of SETs in the cardia is challenging., Aim: To evaluate the safety and efficacy of endoscopic full-thickness resection (EFTR) for the treatment of gastric cardia SETs., Methods: We retrospectively reviewed data from all patients with SETs originating from the muscularis propria layer in the gastric cardia that were treated by EFTR or submucosal tunneling ER (STER) at Zhongshan Hospital Fudan University between November 2014 and May 2022. Baseline characteristics and clinical outcomes, including procedure times and complications rates, were compared between groups of patients receiving EFTR and STER., Results: A total of 171 tumors were successfully removed [71 (41.5%) tumors in the EFTR and 100 (58.5%) tumors in the STER group]. Gastrointestinal stromal tumors (GISTs) were the most common SET. The en bloc resection rate was 100% in the EFTR group vs 97.0% in STER group ( P > 0.05). Overall, the EFTR group had a higher complete resection rate than the STER group (98.6% vs 91.0%, P < 0.05). The procedure time was also shorter in the EFTR group (44.63 ± 28.66 min vs 53.36 ± 27.34, P < 0.05). The most common major complication in both groups was electrocoagulation syndrome. There was no significant difference in total complications between the two groups (21.1% vs 22.0%, P = 0.89)., Conclusion: EFTR of gastric cardia SETs is a very promising method to facilitate complete resection with similar complications and reduced operative times compared to STER. In cases of suspected GISTs or an unclear diagnosis, EFTR should be recommended to ensure complete resection., Competing Interests: Conflict-of-interest statement: The authors have no conflict of interest to declare., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Carcinosarcoma is a rare malignant neoplasm, consisting of both epithelial and mesenchymal component. Primary gastric carcinosarcoma is rare and poorly understood. We reported clinicopathologic features of 4 cases and analysis of 76 cases published in the literature. Clinical symptoms were nonspecific with epigastric pain, weight loss, and melena, as the most common complaints. The prognosis of patients was dismal with high mortality. The tumor commonly occurred in the upper stomach in Chinese patients, whereas, it was more prevalent at the lower stomach in Japanese and other populations. The two malignant components of this rare cancer showed considerable histological heterogeneity with a wide range of differentiation. We propose that carcinosarcomas be divided in two main subtypes: conventional carcinosarcoma and carcinosarcoma, not-otherwise-specified (NOS). Such distinction may provide useful information for targeted treatment of various sarcomatous components of this tumor. Immunohistochemistry should be routinely applied in the diagnosis of this rare tumor. [ABSTRACT FROM AUTHOR]

The gastric cardia-the small area around the cardiac orifice including the abdominal esophagus-is an important target area for abdominal and thoracic surgeries, especially for laparoscopic procedures. In this study of 28 cadavers, a peritoneal earlobe-like appendage near the angle of His was identified as a useful indicator of the lateral margin of the abdominal esophagus, which is otherwise obscure because the peritoneum continues to the diaphragm without definite demarcation of this margin. This structure, which appears equivalent to the epiploic appendages, was commonly found to be present (in 22/28, 78.6 % of the 28 cadavers) and was 4-21 mm × 6-40 mm × 1-4 mm in size, triangular, round, or leaf-like in shape, contained fat, and was on an imaginary line along which the lesser omentum adheres to the lesser curvature and continues to the diaphragm (18/22, 81.8 %). This indicator is associated with the lesser omentum and is part of the gastrophrenic ligament, and could serve as a useful indicator of the margin of the gastric cardia, thus aiding surgeons performing laparoscopic surgery in this region. [ABSTRACT FROM AUTHOR]