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Eur J Cardiothorac Surg 2005;28:658
© 2005 Elsevier Science NL

Letter to the Editor

Esophago-gastric submucosal lymphatic drainage

Service de chirurgie thoracique Hôpital Européen Georges Pompidou, HEGP, 20 rue Leblanc, 75015 Paris, France

Received 10 March 2005; received in revised form 13 March 2005; accepted 29 June 2005.

^* Corresponding author. Tel.: +33 1 56 09 34 50; fax: +33 1 56 09 33 80. (Email: marc.riquet{at}hop.egp.ap-hop-paris.fr).

Key Words: Esophagus • Cancer • Lymphatics

In their paper published in the December 2004 issue of the journal, Ebihara and colleagues [1] report on 13 cases of intramural stomach metastasis from esophageal squamous cell carcinoma observed among a total of 1259 surgical resections (1.0%). Primary cancer was located in the middle (n=3) or lower esophagus (n=10) and 12 of the 13 (92.3%) had lymphatic invasion. The metastatic tumours resembled submucosal tumors. They suggested that the most likely reason for metastases to form such mucosal tumors was that they occurred via submucosal lymphatic vessels, which was first suggested by Watson in 1933 [2] and further documented by Weinberg in 1972 [3] on a pathology specimen at the level of the stomach. In an anatomic study of the lymphatic drainage of the esophagus in the adult [4], we had the opportunity to observe submucosal lymphatic vessels in nine out of 50 subjects (18%). In three cases, two out of 20 (10%) from the middle and one out of 15 (7%) from the lower esophagus, these submucosal lymphatic vessels made their way downwards to the cardia and fundus so connecting with the stomach lymph drainage.

Demonstration of these submucosal pathway illustrates and further supports Ebihara and coll's hypothesis.

Footnotes

The authors of the original paper [1] were invited to reply to this Letter to the Editor but they did not respond.

References

1. Ebihara Y, Hosokawa M, Kondo S, Katoh H. Thirteen cases with intramural metastasis to the stomach in 1259 patients with oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg 2004;26:1223-1225.[Abstract/Free Full Text]
2. Watson WL. Carcinoma at the esophagus. Surg Gynecol Obstet 1933;56:884-897.
3. Weinberg JA. The lymphatics in cancer. Philadephia: Saunders; 1972p. 245–7.
4. Riquet M, Saab M, Le Pimpec Barthes F, Hidden G. Lymphatic drainage of the esophagus in the adult. Surg Radiol Anat 1993;15:209-211.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marc Riquet Patrick Bagan Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Riquet, M. Articles by Le Pimpec Barthes, F. Search for Related Content PubMed PubMed Citation Articles by Riquet, M. Articles by Le Pimpec Barthes, F. Related Collections Esophagus - cancer