Esophageal Adenocarcinoma in the Proximal Esophageal Segment: A Unique Presentation in a Male With Alcohol Abuse

Abstract

Esophageal adenocarcinoma (EAC) is a malignancy classically seen in the distal esophagus. While many risk factors associated with the condition have been reported, the most common among them are gastroesophageal reflux disease (GERD) and obesity. Histological changes range from metaplasia within the esophagus from stratified squamous epithelium to non-ciliated columnar cells with goblet cells. In contrast, squamous cell carcinoma (SCC) is classically found in the proximal portion of the esophagus and its risk factors include tobacco and alcohol use. We present a unique case of a 59-year-old African American male who presented to the ED with dysphagia, weight loss, and multiple episodes of emesis. Notable medical history included tobacco abuse, alcohol abuse, and alcoholic cirrhosis. Currently, there are numerous case reports delineating unique presentations of esophageal cancers; however, there are few case reports that demonstrate EAC affecting the proximal segment of the esophagus.

Keywords: esophageal adenocarcinoma.

Figure 1. EGD findings

A: mass on initial EGD; B: continuation of mass on initial EGD; C: PEG placement; D: mass on first readmission EGD; E: mass on second readmission EGD with impaction; F: histology of initial biopsy EGD: esophagogastroduodenoscopy; PEG: percutaneous endoscopic gastrostomy