Barrett's esophagus 2

CASE : 0005

Diagnosis & discussion

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Final diagnosis

Well differentiated adenocarcinoma with low-grade atypia of long-segment Barrett's esophagus, cardiac and esophagectomy
Gross: type 4, Size: 75x55mm, Depth of invasion: pT3(AD), ly0/v0, DM0/PM0, pN(2/31)

Diagnosis & discussion

    This case was BE (LSBE) accompanied by an esophageal hiatal hernia, showing partial severe stenosis. The stenosis was circumferential and accompanied by wall thickening. The mucosa in the stenotic area was irregular and coarse. Therefore, advanced cancer (Type 4, diffusely infiltrating type) with LSBE as a background was considered.
    Pathologically, the whole of the resected area was BE covered with columnar epithelium, and adenocarcinoma had developed with this background BE. Although this cancer was invasive, ulceration was not observed. This may have been partly because the lesion was constituted mainly by differentiated adenocarcinoma with low-grade nuclear atypia. The absence of ulceration is characteristic of differentiated adenocarcinoma with low-grade nuclear atypia, not only in the esophagus but also the stomach and large intestine.
    In Western countries, differentiated adenocarcinoma with low-grade atypia is sometimes diagnosed as low- or high-grade dysplasia. However, even in Western countries, surgery has been recommended for low-grade dysplasia in Barrett's esophagus and ulcerative colitis. Thus, adequate consideration should be given to the possibility of differentiated adenocarcinoma with low-grade nuclear atypia in cases of adenocarcinoma in BE.
    In the background of this BE, there was no intestinal metaplasia on the gastric side, but columnar epithelium accompanied by goblet cell metaplasia was observed on the oral side. This epithelium resulted from goblet cell metaplasia in gastric-type foveolar epithelium, and was mixed gastric- and intestinal-type columnar epithelium. Such intestinal metaplasia is frequently observed in BE.
Contributor: Tadakazu Shimoda
Ichiro Oda
Institution: National Cancer Center
Country: Japan
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