We report here the case of a 78-year-old man who developed a recurrence of an adenocarcinoma,
15 months after initial endoscopic mucosal resection (EMR) of adenocarcinoma arising
from short-segment Barrett’s esophagus. The recurrent adenocarcinoma had the appearance
of a submucosal tumor and was found in an area of squamous epithelium. The new lesion
was resected by EMR and the patient has had no further recurrences for 32 months.
In the initial endoscopic examination, a red area of short-segment Barrett’s esophagus
was detected (Figure [1]). The patient underwent examination by magnifying endoscopy and an irregularly round
pit and abnormal capillaries were revealed as a cancerous area. The pathological diagnosis
was adenocarcinoma. EMR was performed in February 2001. Histological investigation
of the proximal edge of the tumor revealed slight submucosal invasion and squamous
epithelium covering the carcinoma: the proximal margin of the resected tissue was
defined as carcinoma-negative. The diameter of the cancer was 10 mm. Fifteen months
after EMR, endoscopic examination revealed a submucosal tumor-like lesion with a nodular
appearance in the area of squamous epithelium proximal to the original site of the
tumor (Figure [2 a]). Two biopsy specimens taken from this area showed adenocarcinoma covered by squamous
epithelium. This lesion was resected by EMR and was found to be a well-differentiated
adenocarcinoma, 1.5 mm in diameter, located in the lamina propria and covered with
squamous epithelium (Figure [2 b]). Endoscopic examination was repeated after the second EMR and no residual or recurrent
lesion has been found at the latest follow-up examination in January 2005, 32 months
after the second EMR. Recently, adenocarcinoma arising from Barrett’s esophagus has
been treated by EMR [1]
[2]
[3]
[4]
[5]. Giovannini et al. [5] reported that out of 21 patients whose tumor resection by EMR was initially classified
as complete, two patients later presented with local recurrence and underwent further
treament by EMR. Follow-up endoscopic surveillance for tumor recurrence is necessary
after initial EMR treament, because EMR has the potential to become a complete therapy
in terms of long-term survival of patients with this disease.
Figure 1 The initial conventional endoscopic examination showed short-segment Barrett’s esophagus
and slight redness of the mucosa. The region outlined by the yellow box indicates
the area of adenocarcinoma.
Figure 2 Fifteen months after the original EMR, follow-up endoscopic examination showed a submucosal
tumor-like lesion with a nodular appearance, proximal to the squamocolumnar junction
(a). Histological examination showed this lesion to be a well-differentiated adenocarcinoma
in the lamina propria, 1.5 mm in diameter, and covered by squamous epithelium (b).
Competing interests: None
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