Adenocarcinoma of the upper esophagus

Primary adenocarcinoma of the upper esophagus: A rare presentation

INTRODUCTION AND IMPORTANCE

Cervical esophageal cancer is a rare condition, accounting for less than 5 % of all esophageal malignancies.

CASE PRESENTATION

We report here a case of a 65-year-old female patient with a history of breast cancer diagnosed in 1985 treated with surgery, adjuvant chemotherapy, and radiotherapy. This woman presented with chronic organic high dysphagia to both solid and liquids and food impaction. Gastroscopy showed a stenosing esophageal budding tumor located at 20 cm from the incisors. Histological examination showed a well-differentiated adenocarcinoma.

CLINICAL DISCUSSION

The diagnosis of primary adenocarcinoma of the upper esophagus is based on a combination of clinical presentation, imaging studies, and confirmed by histopathological examination. Upper digestive endoscopy is the gold standard for the diagnosis of esophageal cancer.

CONCLUSION

Primary adenocarcinoma of the upper esophagus is a rare form of esophageal cancer.

Human Epidermal Growth Factor Receptor 2-positive Primary Adenocarcinoma in the Cervical Oesophagus: A Case Report

BACKGROUND/AIM

Cervical oesophageal adenocarcinoma (COA) is extremely rare. We present a case of human epidermal growth factor receptor 2 (HER2)-positive COA that showed repeated recurrences despite multidisciplinary treatments.

CASE REPORT

A 49-year-old male was diagnosed with clinical stage IVA COA that originated from ectopic gastric mucosa. He initially underwent definitive chemoradiotherapy (CRT) (60.0 Gy/30 fractions, 5-fluorouracil, and cisplatin). Two months after CRT, the right supraclavicular lymph node (LN) reenlarged and salvage lymphadenectomy was performed. Immunohistochemical staining revealed a HER2-positive adenocarcinoma. Four months after lymphadenectomy, multiple metastases in the mediastinal LNs and lungs were detected, and S-1, oxaliplatin and trastuzumab were administered. Four months after chemotherapy, the patient presented with new liver metastasis. Further metastasis was prevented by Nivolumab treatment for four months.

CONCLUSION

HER2-positive COA may be more aggressive and may require further intensive treatments. This literature review may be helpful in determining treatment strategies for COA.

Gastric inlet patches: symptomatic or silent?

PURPOSE OF REVIEW

The purpose of this review is to assess recent literature on the clinical relevance of the gastric inlet patch with particular focus on endoscopic diagnosis and treatment, the relationship of the inlet patch to laryngopharyngeal reflux disease and the association of proximal esophageal adenocarcinoma with inlet patch.

RECENT FINDINGS

Recent studies suggest endoscopic diagnosis of inlet patch increases with endoscopist awareness (up to 10-fold) and when using enhanced imaging techniques such as narrow band imaging (up to three-fold). The literature remains mixed on the association of inlet patch with laryngopharyngeal symptoms or globus sensation. Studies of endoscopic ablation, using argon plasma coagulation or radiofrequency ablation have shown improved laryngopharyngeal reflux symptom scores posttreatment. Proximal esophageal adenocarcinomas are rare but often associated with inlet patch when they occur. Case studies have described endoscopic resection of malignant lesions related to inlet patch, using endoscopic mucosal resection or submucosal dissection.

SUMMARY

Prospective, multicenter studies of symptom association with inlet patch using validated symptom questionnaires and blinded sham-controlled treatments are needed to further clarify the role of such treatments, which to date are limited to a small numbers of centers with a special interest.

Primary adenocarcinoma of the upper oesophagus

Upper oesophageal adenocarcinoma is a rare malignancy that occurs in the ectopic gastric mucosa, in the upper part of the oesophagus. Only 29 cases so far have been reported. We report the 30th case in a 50-year-old Asian female presenting with difficulty in swallowing.