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Digital Library: Case Studies: The Gastrointestinal Tract: Case 1: Esophageal Cancer 60-year old man with difficulty swallowing.
Past history: Smokes 2 packs per day. Drinks up to 5 martinis per day. Chief complaint: Difficulty swallowing (dysphagia) noted one month ago. Clinical findings: Barium swallow esophagram disclosed a lesion in the lower esophagus. Upper endoscopy with biopsy and brushings of the lesion for cytologic examination led to a diagnosis of malignancy. An esophagogastrectomy was subsequently performed.
Macroscopic appearance of the resected specimen. Describe the lesion. The diagnosis is squamous cell carcinoma. A 2.5 cm friable ulcer is seen in the distal esophagus, located approximately 1.5 cm away from the gastroesophageal carcinoma junction. Grey glistening, squamous mucosa is present distal to the lesion, separating it from the more tan, rugal folds of the stomach. Smoking and alcohol abuse are believed to be significant risk factors.
Macroscopic appearance of an esophagogastrectomy specimen from another patient. Describe the lesion. The diagnosis is adenocarcinoma arising in Barrett esophagus. Glistening grey squamous mucosa is seen to the left of the photograph, while the gastric rugal folds are seen on the right side. A 5 cm depressed lesion with an obvious central ulcer is seen. The lesion is centered in the distal esophagus esophagus with no interposition of grey squamous mucosa between it and the stomach. Its color is similar to the mucosa of the stomach. Replacement of the squamous mucosa with glandular epithelium is most obvious at the left edge of the lesion.
Review the basic concepts of esophageal carcinogenesis, including a distict pathogenesis for the two basic histologic types of cancer.
This specimen demonstrates an adenocarcinoma arising in the stomach.
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Question for Class Discussion