Early Gastroesophageal Junction Adenocarinoma detection: A

Demonstrative Case Report

Dr. Rose-Belle Rahon-Sucgang

Dr. Jackeline Lao
Dr. Hamil Romulo B. Guerrero

Abstract

We present a 42 year old Caucasian male who suffered a sudden onset of

dysphagia for 5 months. The esophagogastroduodenoscopy (EGD) revealed a
narrowing at the distal part of the esophagus down to the ensophagogastric junction
which was also erythematous and friable. Computed tomography (CT) scan showed
circumferential wall thickening involving the distal 3 rd of the esophagus and
gastroesophageal junction extending to the gastric cardia and lesser curvature of the
gastric body, causing severe esophageal luminal narrowing and secondary moderate
dilatation of the rest of the esophagus proximal to the lesion. Prominent distal
paraesophageal, gastroesophageal and perigastric lymph nodes were noted. The
histopathology report of the specimens taken from EGD exhibited a poorly differentiated
adenocarcinoma.

Introduction

Esophageal cancer (EsC) is one of the least studied and deadliest cancers
worldwide because of its extremely aggressive nature and poor survival rate. It ranks
sixth among all cancers in mortality. Worldwide, 90% of esophageal cancers are
squamous cell carcinomas (SCCs) and about 5% are adenocarcinomas. The remaining
5% represent rare malignancies and metastases from other organs. The most common
presenting symptoms are dysphagia, odynophagia, and weight loss It is one of the
deadliest cancers worldwide with 5-year survival rates of 5.0-26.2% and the eighth most
common cancer worldwide There are two major types of esophageal cancer:
esophageal adenocarcinoma (EAC) and esophageal squamous cell cancer (ESCC)
EAC arises from the distal third of the esophagus and is commonly found in Caucasian
men. ESCC arises from the proximal two-thirds of the esophagus and is commonly
found in African Americans and Caucasian females.
Case presentation

A 42-year-old Caucasian male who was apparently well not until 5 months prior
to hospitalization the patient complained of odynophagia, dysphagia and weight loss for
5 months. He was able to have several consultations, however, did not improved not
until he was referred to a gastroenterologist. He was workup with
esophagogastroduodenoscopy (EGD) revealed a narrowing at the distal part of the
esophagus down to the ensophagogastric junction which was also erythematous and
friable. Computed tomography (CT) scan showed circumferential wall thickening
involving the distal 3rd of the esophagus and gastroesophageal junction extending to the
gastric cardia and lesser curvature of the gastric body, causing severe esophageal
luminal narrowing and secondary moderate dilatation of the rest of the esophagus
proximal to the lesion. Prominent distal paraesophageal, gastroesophageal and
perigastric lymph nodes were noted. The histopathology report of the specimens taken
from EGD exhibited a poorly differentiated adenocarcinoma. Hence, he was advised
surgical intervention. His past medical history were unremarkable. He had no family
history of heredofamilial diseases such as diabetes, hypertension and malignancies. He
was a known smoker and an alcoholic beverage drinker.

He was then admitted for elective Akiyama Procedure. The pre-operative

laboratory included CBC hgb 12.6 g/dL, hct 0.37, RBC 4.27 x 10 12/L, WBC 5.5 x 10
12/L, Neutrophils 61%, Lymphocytes 36%, platelet count 259 x 10 9/L, ABO type “A+”;
blood chemistry Fasting blood sugar 94 mg/dl, Sodium 141.6 mmol/dl, Potassium 4.11
mmol/dl, SGOT 16.0 u/l, SGPT 27.40 u/l, Creatinine 1.19 mg/dl; Chest XRAY –normal
chest findings.

The patient underwent the Akiyama procedure; transthoracic distal

esophagectomy with total gastrectomy, D2 lymphadectomy, esophagojejunostomy roux
en y, bilateral tube thoracostomy, feeding tube jejunosotmy, drain.

The course in the ward was uneventful, thus, patient was discharged after 11 th
post-operative day. He was advised to follow up with repeat
esophagogastroduodenoscopy.

Discussion

Carcinoma of esophagus carries poor survival if it is not surgically resectable.

According to the American Cancer Society, the 5-year survival rate for regional
carcinoma of esophagus was only 21%. Dysphagia is common in older adults, affecting
up to 15% of the population.
The present case report demonstrates the importance of diagnosing esophageal cancer
early, particularly in young patients, as advanced disease carries a devastating
prognosis.

This case is a classic picture of a gastroesophageal junction adenocarcinoma.

The type of esophageal cancer that is uncommon. The most common clinical
presentation was dysphagia, odynophagia and weight loss which were seen on the
patient.

The pre-operative care including the diagnostic workup EGD, computed

tomography scan and pre-operative risk evaluation were all carried out. The surgical
treatment was properly executed with less post-operative complication noted.

Conclusion

The case report present a typical feature of esophageal cancer specifically GEJ
adenocarcinoma. This is a reminder to clinicians that early detection through proper
history, physical examination and the aid of diagnostic tests will greatly increase the
success rate of treatment.