A case of an early adenocarcinoma arising in an extremely long Barrett's esophagus

Barrett's esophagus and subsequent adenocarcinoma have been increasingly encountered in the Japanese population due to dissemination of the Euroamerican lifestyle. We report a case of Barrett's adenocarcinoma in an extremely long Barrett's esophagus. A 45-year-old man followed up regularly for symptomatic gastroesophageal reflux diseases (GERD) was admitted for further examination of an abnormal shadow in the lower esophagus identified by an upper gastrointestinal series. Endoscopy showed a 3-cm type 2 tumor at the lower part of an extremely widespread Barrett's esophagus 15 cm long. Tumor biopsy showed adenocarcinoma. The patient remains alive and recurrence-free 2 years and 9 months after radical thoracic esophagectomy with regional lymphadenectomy. Pathological diagnosis showed moderately differentiated adenocarcinoma invading the submucosal layer, but without lymphatic or vascular invasion. Immunohistochemical staining showed that both the adenocarcinoma and adjacent noncancerous Barrett's epithelium in the posterior wall of the esophagus were positive for p53 mutation, suggesting its association with the development of Barrett's esophagus and subsequent adenocarcinoma. To our knowledge, our patient had the most widespread Barrett's esophagus in Japanese patients with complications of esophageal adenocarcinoma. Patients with early Barrett's adenocarcinoma are reported to enjoy an extremely favorable prognosis with proper surgical treatment. Endoscopic GERD follow-up may therefore play a crucial role in the early detection of Barrett's adenocarcinomas, leading to improved overall prognosis for patients developing this malignancy.