A case report of Barrett's esophageal adenocarcinoma in a young adult aged 20 years

Abstract

In Japan, the prevalence of Barrett's esophageal adenocarcinoma (BEA) has recently increased owing to a decrease in the number of patients with Helicobacter pylori infection, westernization of the diet, and an increase in obesity prevalence. However, BEA in patients in their 20s is extremely rare. Our patient was a 20-year-old Japanese woman with chief complaints of vomiting and nausea. Esophagogastroduodenoscopy was performed to investigate the cause of vomiting, and a raised lesion was found in the gastroesophageal junctional zone. In the magnified observation, the mucosal pattern of the lesion was partially invisible, and the vascular pattern was irregular; the lesion was diagnosed based on the Japan Esophageal Society classification for Barrett's esophagus -related superficial neoplasia. Endocytoscopic observations revealed a highly irregular glandular structure. Computed tomography showed no distant metastasis. Based on these results, we diagnosed BEA as short-segment Barrett's esophagus and performed an endoscopic submucosal dissection. The pathological diagnosis was pT1a-DMM. It was a well-differentiated adenocarcinoma and was treated with curative resection. BEA is extremely rare in young adults in their 20s. Nonetheless, appropriate surveillance is required for patients with multiple risk factors, including obesity and exposure to acid and bile resulting from persistent vomiting.

Keywords: Barrett's esophageal adenocarcinoma; Barrett's esophagus; esophageal neoplasms; image enhanced endoscopy; young adult.

FIGURE 1

Endoscopic white light imaging pictures. (a) The flat elevated lesion is observed with a short segment of Barrett's esophagus. (b, c) The lesion is located at the 2 o'clock position, and a slight depression is observed in the center of the lesion. (d) The anal border of the lesion is clearly observed from the retroflex position.

FIGURE 2

Endoscopic pictures of narrow‐band imaging and endocytoscopic imaging. (a) The lesion is observed as a brownish area. (b, c) The mucosal pattern of the lesion is partially invisible, and the vascular pattern is visible and irregular. (d) Endocytoscopic observation showed disturbed polarity of the cellular arrangement and a highly irregular glandular structure.

FIGURE 3

Resected specimen and mapping. (a) The tumor measures 12 × 9 mm. (b) The red line shows a well‐differentiated adenocarcinoma in the depressed area. The oral side of the lesion shows subcutaneous extension in the area indicated by the green line.

FIGURE 4

Histopathological image. (a) The background mucosa exhibits features of Barrett's esophagus, as the mucosal muscularis is multilayered and contains stratified squamous epithelium and esophageal glandular ducts. (b) The atypical glandular epithelium is proliferating, forming irregular tubular glandular structures of various sizes. (c) The carcinoma extends to the multilayered muscularis mucosae and partially shows subepithelial extension.