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. 2023 Jul 20;9(1):132.
doi: 10.1186/s40792-023-01707-7.

Adenocarcinoma arising from widespread heterotopic gastric mucosa in the cervicothoracic esophagus: a case report

Shohei Nogi  1 , Kazuhiro Noma  2 , Masashi Hashimoto  1 , Takuya Kato  1 , Naoaki Maeda  1 , Shunsuke Tanabe  1 , Yasuhiro Shirakawa  3 , Toshiyoshi Fujiwara  1
Affiliations

Adenocarcinoma arising from widespread heterotopic gastric mucosa in the cervicothoracic esophagus: a case report

Shohei Nogi et al. Surg Case Rep. .

Abstract

Background: In Japan, about 6% of esophageal cancers are adenocarcinomas, although most of them arise from Barrett's epithelium. Adenocarcinoma arising from heterotopic gastric mucosa (HGM) is very rare. Due to its rarity, there is no unified view on its treatment strategy and prognosis.

Case presentation: A 57-year-old man presented with a protruding lesion in the cervicothoracic esophagus that was detected by an upper gastrointestinal series at a medical checkup. Esophagoscopy revealed a 30 mm Type 1 tumor circumferentially surrounded by widespread HGM. Computed tomography (CT) and fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT showed no metastasis or invasion of the surrounding organs. We diagnosed the lesion as cT2N0M0 cStageIIB [Union for International Cancer Control (UICC) 8th Ed] cancer and performed subtotal esophagectomy with three-field lymph node dissection. The tumor was determined to be a well-differentiated adenocarcinoma arising from HGM, with deep invasion of the submucosa. The patient underwent no adjuvant therapy and has currently survived without any evidence of recurrence for 15 months.

Conclusions: Although the treatment for adenocarcinoma arising from HGM is basically the same as that for squamous cell carcinoma (SCC) of the esophagus, it is important to determine the treatment strategy based on the characteristics of the adenocarcinoma arising from HGM.

Keywords: Adenocarcinoma; Esophagus; Heterotopic gastric mucosa.

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Conflict of interest statement

The authors declare that they do not have any competing interests.

Figures

Fig. 1
Fig. 1
Esophagoscopy findings. a Widespread HGM extended from 16 to 24 cm distal to the incisor teeth. b Type 1 tumor circumferentially surrounded by HGM
Fig. 2
Fig. 2
Barium esophagography images. Front view (a) and left oblique view (b) showing an irregular elevated lesion in the posterior wall of the cervicothoracic esophagus (arrowhead)
Fig. 3
Fig. 3
Contrast-enhanced CT and FDG–PET/CT images. a Contrast-enhanced CT showed enhanced wall thickening in the cervicothoracic esophagus that displaced the trachea to the right side. b FDG–PET/CT showed high FDG uptake with a maximum SUV of 21.6 only in the primary lesion
Fig. 4
Fig. 4
Resected esophageal carcinoma specimen. a Gross evaluation showed a type 0-I + 0-IIa tumor, 43 × 40 mm in the cervicothoracic esophagus. b Enlarged view showing the salmon colored mucosa (yellow line) circumferentially surrounding the tumor (red line)
Fig. 5
Fig. 5
Pathological evaluation of the resected specimen. a Hematoxylin and eosin (H.E.) staining showed a well-differentiated tubular adenocarcinoma infiltrating deep into the submucosa. b Microscopic evaluation showed grades of HGM without atypia, and intraepithelial carcinoma. The HGM without atypia contained gastric fundic glands with parietal cells without intestinal metaplasia or Helicobacter pylori infection
Fig. 6
Fig. 6
Results of immunohistochemical analysis. a MUC5AC staining was positive mainly in the invasive area. b MUC6 staining was positive mainly in the invasive area, as with MUC5AC. c MUC2 was partially positive in the surface layer of the tumor
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