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Esophageal Adenocarcinoma Arising from Barrett’s Dysplasia: A Case Report of Double Occurrence and Prolonged Survival after Chemotherapy

Hemender S. Vats, MD, Department of General Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449
Tarit K. Banerjee, MD, FACP, Department of Hematology/Oncology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 5444
Jeffrey Resnick, MD, Department of Pathology, Marshfield Laboratories, 1000 North Oak Avenue, Marshfield, WI 54449
Qaseem Khan, MD, Department of Hematology/Oncology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449

Reprint Requests: Hemender Singh Vats, MD, Department of General Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, Tel: 715-387-5537, Fax: 715-389-3808, Email: vats.hemender{at}marshfieldclinic.org

A relatively young patient with chronic gastroesophageal reflux disease (GERD), obesity, smoking, and alcohol intake presented with widespread metastatic disease in lymph nodes, liver and lungs from a lower esophageal adenocarcinoma extending into the gastroesophageal junction associated with Barrett’s mucosa and dysplasia.A complete response was achieved with six cycles of chemotherapy that sustained for more than 4 years without further recurrence. Unfortunately, there was presence of esophageal metaplasia after complete response which eventually converted to low to high grade dysplasia and ultimately to a second primary localized lower esophageal adenocarcinoma that was treated with thoracoabdominal esophagectomy and lymphadenectomy. No evidence of disease recurrence was seen 2 years later. The pathogenesis of a recent increase in the incidence of GERD, Barrett’s esophagus and lower esophageal adenocarcinoma are discussed. Surgery, radiotherapy and combination chemotherapy are effective in the early stages leading to tumor shrinkage and prolongation of life and even cure in some cases. Lower esophageal adenocarcinoma is frequently associated with Barrett’s high-grade dysplasia. Since there has been a dramatic increase in the incidence of Barrett’s dysplasia, appropriate surveillance with upper gastrointestinal endoscopy and preventive strategies, such as the use of aspirin, cyclo-oxygenase II inhibitors and other nonsteroidal antiinflammatory drugs known to be chemopreventive agents against colon, esophagus, gastric and bladder cancers, need to be studied.

Key Words: Barrett’s esophagus • Dysplasia • Esophageal adenocarcinoma • Gastroesophageal reflux disease