Adenocarcinoma with enteroblastic differentiation with choriocarcinoma components arising in long-segment Barrett's esophagus: a report of autopsy case.
Yuki Sato, Tomio Arai, Kazushi Fukagawa et al.
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Case in brief
An 87-year-old man was admitted with anorexia. Endoscopy showed a nearly circumferential elevated lesion at the lower esophagus and esophagogastric junction; biopsy identified adenocarcinoma with enteroblastic differentiation and small foci of choriocarcinoma. CT showed multiple liver metastases. Long-segment Barrett’s esophagus was present in the background, and the tumor was considered to have arisen from it. The patient died from hematemesis and hypovolemic shock 11 days after admission. Autopsy found tumor hemorrhage with 700 mL of blood in the stomach, as well as extension along intraesophageal and azygos veins and metastases to the liver and lung.
What made this case unusual
The tumor combined enteroblastic differentiation with choriocarcinoma components and arose in the setting of long-segment Barrett’s esophagus; autopsy also showed venous extension and fatal intragastric hemorrhage.
Diagnostic / clinical pearl
In a lower esophageal or esophagogastric junction tumor arising in Barrett’s esophagus, biopsy may reveal enteroblastic differentiation with a choriocarcinoma component; this case also illustrates the potential for extensive metastasis and fatal tumor bleeding.