A CASE OF SUPERFICIAL ADENOCARCINOMA IN BARRETT'S ESOPHAGUS

Abstract

Esophagography revealed a tumorous lesion in a 72-year-old woman. Endoscopy was performed with or with out dye staining 29 cm below the upper incisor teeth and the following three findings were obtained : (1) The mucosa extending toward the cardia had already become reddish with a relatively welldefined margin ; it turned blackish brown after the scattering of Congo red, while it remained unchanged after reaction with Lugol's solution. (2) The mucosa extending oral reacted only with Lugol's solution. (Based on the above two findings, the case was diagnosed as Barrett's esophagus with no hiatal hernia.) (3) A superficial elevated lesion was found in the mucosa extending toward the cardia ; it did not react with the two dyes. The lesion was identified as adenocarcinoma based on biopsy. The patient underwent subtotal esophagectomy and retrosternal esophagogastrostomy. Gross observations of the resected organ revealed that the esophagogastric junction was irregular, and that a protruded tumor (2 × 2 cm) was present in the mucosa extending toward the cardia. The tumor was histopathologically classified as well-differentiated adenocarcinoma which invaded the submucosa and metastasized to an adjacent lymph node. Barrett's esophagus was microscopically shown to have (a) a mixture of fundic-, intestinal- and junctional-type epithelia, (b) esophageal glands in the submucosa, and (c) squamous epithelia like islets in the columnar epithelium. These three histopathological findings suggested that Barrett's esophagus in the patient might be of the acquired type.