Endoscopy 2014; 46(S 01): E24-E25
DOI: 10.1055/s-0033-1358807
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic resection of an adenocarcinoma occurring in ectopic gastric mucosa within the proximal esophagus

Oliver Möschler
1   Department of Internal Medicine/Gastroenterology, Marienhospital Osnabrück, Osnabrück, Germany
,
Michael Vieth
2   Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
,
Michael K. Müller
1   Department of Internal Medicine/Gastroenterology, Marienhospital Osnabrück, Osnabrück, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
12 February 2014 (online)

An 83-year-old man underwent esophagogastroduodenoscopy (EGD) in an outpatient center because of symptoms of reflux. At endoscopy a slightly elevated type-IIa lesion was detected in the upper esophagus at 18 cm from the incisors ([Fig. 1 a, b]). An adenocarcinoma of the esophagus was diagnosed by biopsies from the lesion, and the patient was referred to our endoscopy unit for further treatment.

Fig. 1 Endoscopic views in an 83-year-old man with symptoms of reflux showing: a a slightly elevated lesion in the upper esophagus at 18 cm from the incisors using white-light endoscopy; b the same lesion using narrow band imaging; c the resection site following en bloc removal by endoscopic resection using the suck-and-cut method.

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First the histopathological diagnosis of an adenocarcinoma in an area of heterotopic gastric mucosa was confirmed by a specialist pathologist and staging investigations were performed. It was then decided that we would carry out endoscopic resection of the lesion using the suck-and-cut method. Because of the extremely proximal location of the lesion, the intervention had to be carried out with the patient under general anesthesia in order to prevent aspiration should bleeding occur. We were able to remove the lesion en bloc ([Fig. 1 c] and [Fig. 2]). The patient’s course following the intervention was uneventful.

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Fig. 2 Macroscopic appearance of the resected specimen.

Histopathological analysis of the resected specimen revealed a well-differentiated adenocarcinoma of the mucosal layer, with involvement of a single lymphatic vessel (T1a [m-type], L1, V0, R0 [HM0, VM0], G2) in a small area of heterotopic gastric mucosa ([Fig. 3]).

Fig. 3 Microscopic appearance of the hematoxylin and eosin (H&E)-stained resected tissue showing: a the lateral margin of the resected tumor, a well-differentiated adenocarcinoma of the mucosal layer; b invasion into a lymphatic vessel, consistent with L1 staging.

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Adenocarcinoma of the proximal esophagus has been reported in only some 30 cases since 1950 [1] [2]. In the majority of these cases, the patients had advanced tumors, so most of them were treated by esophagectomy, radiotherapy, and/or chemotherapy [1]. Only two previous cases of endoscopically treated early carcinoma of the proximal esophagus have been reported, by Pech et al. in 2001 and Hirayama et al. in 2003 [3] [4]. In both cases, the lesion was removed endoscopically without side effects.

The present case illustrates the usefulness of well-established endoscopic mucosal resection techniques in the treatment of early adenocarcinoma in the proximal esophagus.

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  • References

  • 1 Komori S, Osada S, Tanaka Y et al. A case of esophageal adenocarcinoma arising from the ectopic gastric mucosa in the thoracic esophagus. Rare Tumors 2010; 2: e5
  • 2 Verma YP, Chauhan AK, Sen R. Primary adenocarcinoma of the upper esophagus. Ecancermedicalscience 2013; 7: 314
  • 3 Pech O, May A, Gossner L et al. Early stage adenocarcinoma of the esophagus arising in circular heterotopic gastric mucosa treated by endoscopic mucosal resection. Gastrointest Endosc 2001; 54: 656-658
  • 4 Hirayama N, Arima M, Miyazaki S et al. Endoscopic mucosal resection of adenocarcinoma arising in ectopic gastric mucosa in the cervical esophagus: case report. Gastrointest Endosc 2003; 57: 263-266