Multiple early esophageal cancers arising from Barrett's esophagus, and a review of cases of early adenocarcinoma in Barrett's esophagus in Japan

Abstract

A case of early esophageal adenocarcinoma arising in Barrett's esophagus is reported. Many cases of Barrett's esophagus, which is considered a premalignant condition, have been reported in Western countries, but few cases have been reported in Japan. The patient, a 53-year-old man with nausea and vomiting, was a drinker (four glasses wine/day for about 30 years), but did not smoke. He had had a hiatal hernia of the esophagus. Since endoscopic biopsies demonstrated an early adenocarcinoma in Barrett's esophagus, subtotal esophagectomy was performed. In the resected esophageal material, Barrett's esophagus was seen to extend for 12 cm. In addition to the cancer detected preoperatively as a 0-IIc lesion (1.5 cm in diameter), a 0-IIb lesion (1.5 cm in diameter) was also detected in the postoperative survey. Both lesions were well differentiated adenocarcinoma that had invaded only into the lamina propria mucosa. The 23 cases of early adenocarcinoma in Barrett's esophagus that have been reported in Japan were reviewed, and it was learned that the present case is the second of multiple early cancer arising in Barrett's esophagus so far reported in Japan.

High-grade dysplasia and superficial adenocarcinoma in Barrett's esophagus: histological mapping and expression of p53, p21 and Bcl-2 oncoproteins

“…Metaplastic mucosa, dysplasia and adenocarcinoma were strongly intermixed confirming the metaplasia-dysplasia-carcinoma sequence in the neoplastic progression of BE. Superficial adenocarcinoma can also be multifocal [12,14]. Although it has been suggested that superficial adenocarcinoma develops most of the time close to the squamocolumnar junction [18], in our series as in other reports, adenocarcinomas occur in any part of BE including the lower part [14].…”

Endoscopic Ultrasonography of the Esophagus

“…In Japan and Asia, the majority of esophageal carcinomas are of squamous cell origin, whereas in Western countries the reports on adenocarcinoma complicating Barrett's epithelium in relation to regurgitation esophagitis are increasing [24 -26]. Due to our limited experience with EUS on this particular category at present [27], the discussion will have to await future developments, however, the use of the miniprobe scanner will extend the possibility of early detection of adenocarcinoma complicating esophageal dysplasia of this particular disease entity.…”