Residency Program - Case of the Month

Answer:

Moderately differentiated invasive adenocarcinoma, morphologically and immunophenotypically consistent with esophageal adenocarcinoma.

Discussion:

Esophageal  adenocarcinoma  is a malignant epithelial tumor with glandular differentiation.  For the past three decades, the frequency of adenocarcinoma of the esophagus has increased dramatically in Western countries.  A study of a cancer registry in the United States estimated that the age-adjusted incidence rates of esophageal adenocarcinoma rose progressively from 1.8 per 100,000 in 1987 to 1991 to 2.5 per 100,000 during 1992 to 1996 [1]. Esophageal adenocarcinoma is largely a disease of Caucasians and males. The majority of cases are located near the gastroesophageal  junction and are more commonly associated with endoscopic evidence of Barrett’s esophagus. It may present as an ulcer, a nodule, an altered mucosal pattern or no visible endoscopic abnormality [2].

Differential Diagnosis:

Two thirds of all cancers metastatic to muscle are carcinomas, about one third are from leukemias and lymphomas and rare cases originate from melanomas [10]; therefore, although factors in the site may be responsible for the relatively low rates of metastasis to muscle, properties of the primary tumor may also be involved. 50% of carcinomas and sarcomas metastasize to the muscles of the lower extremities. Differentiation between a primary soft tissue sarcoma and metastatic carcinoma to muscle is very important, since their treatment and prognosis are so markedly different.

References:

1. El-Serag HB, Mason AC, Peterson N, Key CR. Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA. Gut 2002;50:368.

2. Paraf F, Flejou JF, Pignon JP,et al. Surgical pathology of adenocarcinoma arising in Barrett’s esophagus. Analysis of 67 cases. Am J Surg Pathol 1995;19:183.

3. Okamoto K, Hrai S, Honma M: Extensive leukaemic cell infiltration into skeletal muscles. Muscle Nerve 1996;19:1052-1054.