Daniel F Gallego1, Florencia G Jalikis2 and Deepti M Reddi1*
1Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, USA 2Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, USAFulltext PDF
Adenocarcinoma is the most common type of esophageal cancer in the United States. We present a rare report of an esophageal cancer with adenocarcinoma, neuroendocrine and squamous cell differentiation, arising from goblet cell metaplasia. The patient was a 58 year-old man with a remote history of orthotopic heart transplantation for ischemic cardiomyopathy who presented with intractable nausea, vomiting, abdominal pain and watery diarrhea. A computed tomography scan revealed a solitary lung nodule, lymphadenopathy and multiple hypoattenuated liver lesions. Upper endoscopy identified a large ulcerated gastroesophageal junction mass with extension into the gastric cardia. Biopsies of the liver and gastroesophageal lesions revealed a poorly differentiated neoplasm with patchy myxoid stroma and dyskeratosis. The overlying esophageal epithelium showed goblet cell metaplasia, seen in Barrett esophagus. By immunohistochemistry, the neoplastic cells were variable expression of MOC-31 and p63, and strongly positive for synaptophysin, consistent with multidirectional differentiation. Clinical laboratory tests found elevated Chromogranin A (811 ng/ mL). The patient rapidly deteriorated within weeks of the diagnosis with progressive somnolence and confusion. Here we present an exceptionally rare case of an aggressive esophageal carcinoma with multilineage differentiation, arising in a background of goblet cell metaplasia, a precursor lesion of esophageal adenocarcinoma.
Gallego DF, Jalikis FG, Reddi DM. Aggressive Esophageal Carcinoma with Multilineage Differentiation by Immunohistochemistry. Ann Clin Case Rep. 2021; 6: 1939..