Tracheobronchial rests are a rare congenital anomaly where ectopic respiratory tract elements may be found in an abnormal site, such as within the esophageal wall. We present a case of a late presentation of an esophageal intramural tracheobronchial rest with complaints of pain in the left chest wall, vomiting, and loss of appetite for one month. The chest X-ray and mammogram were both normal, but an endoscopy could not be performed due to luminal narrowing. A CT scan shows a well-defined, round, non-enhancing hypodense lesion measuring 2.6 x 2.7 cm in the middle one-third of the esophagus. Upon resection, histopathological examination revealed fragments of tissue lined by pseudostratified ciliated columnar epithelium with respiratory mucinous glands admixed with pools of mucin and underlying strands of skeletal muscle. The subepithelium contains esophageal submucosal glands, which confirm the esophageal origin of the choristoma. The usual presentation is congenital esophageal stenosis at birth with over half of these cases being attributed to tracheobronchial rests. Presentation beyond adolescence is even rarer with a relatively benign course and favorable prognosis. Clinical, radiological, and pathological correlation as well as a high index of suspicion are important to avoid misdiagnosis and to institute optimal treatment.

Introduction and Aim: Diagnosis of gastric cancer continues to remain a challenge, considering the widespread prevalence of precancerous lesions. The local progression and systemic spread are significantly influenced by tumor angiogenesis and lymphangiogenesis. This study aimed to evaluate the immunohistochemical expression of VEGF and  its relationship to tumor grade and stage.   Materials and Methods: This cross sectional study was carried out among 30 patients with gastric carcinoma. The specimens were fixed in buffer formalin, embedded in paraffin, sections were stained with Hematoxylin–Eosin and immunohistochemistry was performed for VEGF as per the standard operating procedure. Evaluation was performed using the VEGF score, based on the intensity of reaction and percent of positive cells.   Results: The reaction for VEGF was positive in 27 from 30 cases (90%). VEGF expression was observed in the cytoplasm of tumor cells, with granular pattern. A strong correlation was found between VEGF expression and lymph node status and grade of the primary (p value <0.014), but not with the stage of the tumor.   Conclusion: VEGF over expression has significance with respect to only site and grade of the tumor and hence the usefulness of targeted therapy in such cases has to be evaluated by molecular studies.