Adenocarcinoma of the upper esophagus arising in heterotopic gastric mucosa: common pathogenesis with Barrett's adenocarcinoma?

Abstract

Adenocarcinoma of the upper esophagus arising in heterotopic gastric mucosa is a rare tumor, with only 15 cases reported to date. We report a case in a 61-year-old man complaining of dysphagia. The upper endoscopy revealed that the tumor measured 3 cm and was 22 cm distant from the incisivors. A hiatal hernia with erosive esophagitis of the distal esophagus was present. On microscopic examination the tumor corresponded to a poorly differentiated adenocarcinoma immunoreactive for cytokeratin (CK) 7 and p53. The surrounding heterotopic gastric mucosa contained foci of intestinal metaplasia immunoreactive for CK7 in the surface epithelium and the entire glands and CK20 in the superficial epithelium and superficial glands. The CK7 and p53 positivity that we observed is very common in Barrett's adenocarcinomas. Moreover, intestinal metaplasia in heterotopic gastric mucosa shows the same CK7/CK20 pattern as specialized Barrett's mucosa. These common features shared by adenocarcinomas of the upper esophagus arising in heterotopic gastric mucosa and adenocarcinoma of the lower esophagus developing on Barrett's mucosa suggest that those two types of cancer have a common pathogenesis, related to gastroesophageal reflux disease.

Use of Magnifying Endoscopy to Identify Early Esophageal Adenocarcinoma in Ectopic Gastric Mucosa of the Cervical Esophagus

“…The reported prevalence of intestinal metaplasia in EGMs is less than 20%, 16 and only 4 cases of intestinal metaplasia in an EGM with adenocarcinoma have been reported. 5,17,18 Therefore, the metaplasia-carcinoma sequence is not the major stream of carcinogenesis in adenocarcinoma arising from an EGM of the cervical esophagus. Furthermore, our patient had no gastroesophageal reflux disease endoscopically and symptomatically, and the relation of the carcinogenesis with gastroesophageal reflux disease was not clarified.…”

Adenocarcinoma of Cervical Esophagus Arising in the Barrett’s Mucosa

“…The association between Barrett's esophagus and HGM has been suggested by many studies. Barrett's mucosa has been described in as many as 20 % of the patients having a HGM [3,8,10]. GERD has been shown as a common feature associated with both of these conditions [11].…”

“…Most of these cases have been described in context with a heterotopic gastric mucosa (HGM) or Barrett's esophagus. The exact pathogenesis for the development of adenocarcinoma in cervical esophagus is not well understood and it has been suggested that adenocarcinoma developing in the HGM and Barrett's mucosa may share common etiopathogenesis [3]. A case of adenocarcinoma of cervical esophagus arising in the Barrett's mucosa is presented here.…”

Adenocarcinoma Arising in a Mediastinal Enteric Cyst

“…The present case was classified as enteric cysts according to the classification of Kirwan et al (2) (4,5).…”