1725 A Case of Latin American Female Diagnosed With Esophageal Adenocarcinoma on Brush Cytology Biopsies

Abstract

INTRODUCTION: In 1975, the incidence of esophageal adenocarcinoma (EAC) was 0.4 cases per 100,000. In 2009, the incidence had risen by 5 fold to 2.58 cases per 100,000, making it one of the fastest growing cancers at this time. Esophagoduodenoscopy (EGD) is the gold standard for diagnosing Barrett’s esophagus (BE), which is a precursor to EAC. With the advent of new techniques of brush cytology sampling, there is potential to broaden our technology and our screening criteria for prevention. We present a rare case of a Latin female who was diagnosed with EAC after goblet cells were incidentally found on brush cytology. CASE DESCRIPTION/METHODS: A 73 year old Latin female with history of hiatal hernia, and H. Pylori presented with heartburn and abdominal pain. The EGD showed foveolar dysplasia at the gastric-esophageal junction. Wide Area Transepithelial Sample Biopsy With 3-Dimensional Computer-Assisted Analysis (WATS3D) showed goblet cell metaplasia. Repeat WATS3D confirmed these results and repeat forceps biopsy showed high grade dysplastic glands consistent with a well differentiated EAC. She underwent endoscopic ultrasound with biopsy and it was staged as T3N2Mx. She had a mucosal resection performed which showed poorly differentiated EAC and was referred to oncology. DISCUSSION: It is predicted that between 2011 and 2030, deaths related to EAC will double the number of those that died between 1991 to 2010. Some studies have shown increased detection rates of EAC precursors including those of BE and esophageal dysplasia (ED). For example, a 2010 study concluded that WATS3d brush biopsy allowed for substantial increases in the detection rates of BE by 39.8% and ED by 87.5%. Another 2017 study revealed an increase of 83% for BE and 88.5% for ED. Thus, cytology brush biopsies can help to diagnose high grade dysplasia and/or cancer with greater than 80% sensitivity and 95% specificity. It is also important to note that for women, the future incidence and mortality rates are also expected to rise in 2030 by approximately 9 times. The population we screen for BE is in white males over 50 who are symptomatic and with risk factors for BE or EAC. However, this is a rare case of a latin female that would not have fallen under these screening guidelines. Because of the rising incidence with worsening mortality contributing to the overall rise in EAC cases, we believe that it is imperative to broaden our screening criteria and to implement new tools such as brush cytology biopsies to a broader population as well.