Regional lymph node metastases in patients with carcinoma of the esophagus are an important prognostic factor. According to the eighth edition of the TNM classification of Malignant Tumors isolated tumor cells (ITCs) are defined as ”single tumor cells or small clusters of cells not more than 0.2mm in greatest extent”. Tumor clusters >0.2mm are classified as metastases. The significance of ITCs is unclear. We undertook two studies of carcinomas of the esophagus, one which included 126 patients with adenocarcinoma (AC) of the EGJ and one with 100 patients with squamous cell carcinoma (SCC). All lymph nodes from the resection specimens were carefully examined. In the ACs ITCs were found in 59 of 3454 lymph nodes. Deeper sectioning revealed a change in status from ITCs to metastases in 29 lymph nodes (49.2%).
In the resections from SCCs ITCs were detected in 10 of 2460 lymph nodes. Deeper sectioning detected metastases in 5 of these (50%).
To obtain an accurate pN category we strongly recommend thorough examination of regional lymph nodes and additional sectioning when ITCs are found.

Dr.Birgitte Federspiel – Primary examination of the Royal College of Pathologists, London 1980 Callender-Binford Fellowship, Armed Forces Institute of Pathology, Washington DC 1985-87 Certified as a specialist in pathology Copenhagen University 1989. Employments: Two years in London (one year at St Stephen’s Hospital 1978-1979, and one year at the Royal Free Hospital 1979 -1980), Eight years at the Armed Forces Institute of Pathology, Washington DC (1984-1989, and 2001-2005, the latter as a visiting scientist). In between these “out of her country” employments, she have worked at various hospitals in Copenhagen. For the past 15 years she had worked at Copenhagen University Hospital in the dept. of GI pathology. She had dealt with CUP for the past nine years. Also she is part of the hospital’s Center of Excellence for neuroendocrine tumors. Her main focus of research is neuroendocrine tumors of the GI tract and the lungs and gastrointestinal pathology.