Nassau University Medical Center East Meadow, NY, United States
Maryem Lodhra, MD, Sarah Malik, MD, Deepthi Kagolanu, MD, Nausheer Khan, MD Nassau University Medical Center, East Meadow, NY
Introduction: Esophageal cancer is ranked the 8th most common type of cancer in the world with predominantly two histological subtypes: Squamous Cell Carcinoma (SCC) and Adenocarcinoma (AC). Adenosquamous carcinoma is a rare form of tumor with mixed components of AC and SCC. We present an atypical case of adenosquamous carcinoma of the esophagogastric junction in a patient with no known risk factors.
Case Description/Methods: A 39-year-old male with no PMH presented to the ED complaining of a 3-month history of worsening abdominal pain and 17lb unintentional weight loss. He described a dull, 10/10, epigastric pain radiating to the RLQ, aggravated with meals and alleviated at times after a bowel movement. No smoking, alcohol or illicit drug use. No significant family history. Labs were remarkable for mild transaminitis (ALT 182, AST 102 and Alkaline phosphatase 499). Abdominal CT revealed significant intra-abdominal ascites of unclear etiology and thickening of the ascending and transverse colon. GI was consulted and patient was started on IV Ciprofloxacin and Flagyl empirically for colitis. EGD showed a 4cm irregular, friable mass at the esophagogastric junction. Biopsies were sent for histopathological diagnosis which revealed moderately differentiated invasive adenosquamous carcinoma. Patient was started on chemotherapy after oncology evaluation. A surgical consultation was obtained with discussion of palliative esophageal stenting vs PEG tube placement due to development of dysphagia during the patient’s hospital course. MRCP was performed in light of uptrending LRTs which showed large volume ascites with infiltration of the omentum concerning for peritoneal carcinomatosis leading to a stage IV clinical diagnosis.
Discussion: Adenosquamous carcinoma (ASC) of the esophagus is a rare malignancy with scarce literature and data available making such cases a challenge as a practitioner. The incidence rates range between 0.37-1% and mostly present in patients age >40. Men are affected more frequently than women with a ratio of 4-8:1. Pathophysiology of ASC is unclear with several proposed theories being investigated. Clinical manifestations of ASC include dysphagia, retrosternal/upper abdominal pain and weight loss. The current approach to management is multimodal including surgical resection in combination with neoadjuvant therapy (chemotherapy and/or radiation). Further case reports and research will lead to advancements in our knowledge and treatment of this rare disease thus improving clinical outcomes.
Figure: EGD showing esophageal mass
Disclosures: Maryem Lodhra indicated no relevant financial relationships. Sarah Malik indicated no relevant financial relationships. Deepthi Kagolanu indicated no relevant financial relationships. Nausheer Khan indicated no relevant financial relationships.
Maryem Lodhra, MD, Sarah Malik, MD, Deepthi Kagolanu, MD, Nausheer Khan, MD. P0344 - Adenosquamous Carcinoma of the Esophagogastric Junction, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.