Adenocarcinoma with enteroblastic differentiation with choriocarcinoma components arising in long-segment Barrett's esophagus: a report of autopsy case.

Abstract

Adenocarcinoma with enteroblastic differentiation (AED) commonly develops in the stomach but rarely occurs at the lower esophagus or esophagogastric junction. This tumor may combine with another subtype such as neuroendocrine carcinoma, conventional adenocarcinoma, and so on. An 87-year-old male patient was admitted to our hospital because of anorexia. Esophagogastroduodenoscopy performed to investigate the cause of anorexia revealed a nearly circumferential elevated lesion at the lower esophagus and esophagogastric junction. Biopsy results showed AED with small foci of choriocarcinoma components. A CT scan showed multiple liver metastases. The patient died 11 days after admission due to hematemesis and hypovolemic shock. Autopsy demonstrated hemorrhage from the tumor, and 700 mL of blood had accumulated in the stomach, being a direct cause of death. As long-segment of Barrett's esophagus (LSBE) was observed in the background of the tumor, the tumor was considered to originate from LSBE. The tumor also extended along the intraesophageal and azygos veins and metastasized to the liver and lung. These results suggest that a peculiar type of carcinoma with aggressive biological behavior occurs in the LSBE.