Adenocarcinoma in Barrett's Esophagus after the Operation for Esophageal Achalasia

Toshitaka Mamiya, Kazuhiko Jingu and Toshiyuki Natsume

Department of Surgery, Satte General Hospital

In this paper, we present a case of adenocarcinoma developing in Barrett's esophagus (BE) after operation for esophageal achalasia. A 43-year-old woman was admitted with a 4-month history of progressive dysphagia in January 2003. She had been diagnosed as having esophageal achalasia at the age of 19 years and had undergone a 'Gastric patch'. Esophagography demonstrated a dilated esophagus and an irregular mass in the distal esophagus. Endoscopic findings revealed a tumor measuring 5 cm which was surrounded by the columnar epithelium of BE in the most distal portion of the esophagus. Endoscopic biopsies revealed the diagnosis of adenocarcinoma. A thoraco-abdominal esophagectomy with upper gastric resection was performed. Histological examination revealed a poorly differentiated adenocarcinoma arising from Barrett's esophagus, stage T3, N4, M0, and Stage IVa lesion. Chemotherapy with TS-1 was started postoperatively. Until August 2004, the patient remained clinically well and on chemotherapy. However, she died in December 2004 because of a recurrence in the liver. Adenocarcinoma in Barrett's esophagus is extraordinarily rare in patients with achalasia. Including the present case, only 7 cases have been reported until now.

Key words
achalasia, adenocarcinoma, gastric patch

Reprint requests
Kazuhiko Jingu Department of Surgery, Satte General Hospital
4-14-24 Higashi, Satte, 340-0114 JAPAN

Accepted
July 25, 2007

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