P4003 - Esophageal Adenocarcinoma Arising From Polypoid Dysplasia in Barrett’s Esophagus: A Rare Sequelae

Lefika Bathobakae, MD¹, Atang Koodirile, BS², Angela Vidreiro, MD³, Gabriel Melki, MD⁴, Kamal Amer, MD⁴, Yana Cavanagh, MD^4
1St. Joseph's University Medical Center, Paterson, NJ; ²American University of Antigua College of Medicine, Coolidge, Antigua, Paterson, NJ; ³St. George’s University School of Medicine, Grenada, West Indies, Paterson, NJ; ⁴St. Joseph's University Medical Center, Paterson, NJ

Introduction: Barrett’s esophagus (BE) is intestinal metaplasia of the distal esophageal squamous epithelium and is a known precursor to esophageal adenocarcinoma (EAC). Dysplasia in BE typically manifests as flat lesions that are not detectable on endoscopy. Polypoid lesions of the esophagus are rare and most are solitary. Herein, we report an extremely rare case of EAC arising from a large villous adenoma with high-grade dysplasia.

Case Description/Methods: A 62-year-old male with a history of HTN, tobacco use disorder, and a family history of esophageal cancer was referred to our interventional GI clinic for further evaluation of an esophageal mass. The patient was initially seen in the GI clinic for dysphagia to solid foods. He denied nausea, acid reflux, odynophagia, choking, or nasal regurgitation. Outpatient EGD showed a large, fungating mass in the mid-distal esophagus, 35 to 40 cm from the incisors. The mass was partially obstructing and not circumferential. Erosive gastropathy with stigmata of recent bleeding and erythematous duodenopathy were also noted. Histopathology of the esophageal mass revealed a moderately-to-poorly differentiated invasive adenocarcinoma.



A repeat EGD with EUS revealed a malignant esophageal tumor in the lower third of the esophagus, measuring 20.4 in thickness, which was staged T1sm N0 Mx by endosonographic criteria (Figure 1). Complete removal was accomplished with endoscopic submucosal dissection (ESD) and hemostatic spray was applied to prevent bleeding (Figure 1). The pathology of the resected mass revealed a focal invasive adenocarcinoma, arising from a large villous adenoma with high-grade dysplasia and intramucosal carcinoma. PET scan showed no evidence of distant disease and the patient underwent Ivor-Lewis esophagectomy with jejunostomy tube placement. The patient will follow-up with our clinic in one year for post surgery surveillance EGD.

Discussion: BE is associated with an increased risk of adenocarcinoma, occurring via the metaplasia-dysplasia-carcinoma sequence. The dysplasia typically manifests as flat, grossly undetectable lesions. On rare occasions, BE-associated dysplasia can present as a polypoid lesion. BE-associated polypoid dysplastic lesions have been referred to as adenomas because of their histologic similarity to a colonic adenoma. Treatment options include ablation therapy and endoscopic resection. Esophagectomy can be considered in locally advanced cancers.



Disclosures:


Lefika Bathobakae, MD¹, Atang Koodirile, BS², Angela Vidreiro, MD³, Gabriel Melki, MD⁴, Kamal Amer, MD⁴, Yana Cavanagh, MD⁴. P4003 - Esophageal Adenocarcinoma Arising From Polypoid Dysplasia in Barrett’s Esophagus: A Rare Sequelae, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.