Adenocarcinoma

Clinical

Adenocarcinoma of the esophagus was once thought to be rare entity, because they were previously classified as primary gastric carcinomas that had spread to the esophagus. Most esophageal adenocarcinomas involve the GE junction and the gastric fundus. Most of these cases of adenocarcinoma arise in the background of Barrett's esophagus and account for approximately 5 to 20% of all esophageal carcinomas. Patients often present with dysphagia and weight loss. Less common findings include upper GI bleeding, odynophagia, and chest pain. Most patients have a long standing history of reflux disease. Adenocarcinomas have similar routes of metastases as squamous cell carcinomas, including direct extension, lymphatic spread or hematogenous metastases.

Radiological findings

Early: Early esophageal adenocarcinoma may appear as plaques or flat, sessile polyps in the distal esophagus. In patients with peptic strictures, an early manifestation of adenocarcinoma may appear only as a localized area of flattening or stiffening in the wall of the stricture.

Late: Advanced esophageal adenocarcinomas appear as infiltrating lesions with irregular luminal narrowing or, nodularity or ulceration of the mucosa. Less frequently, adenocarcinomas can appear as a polypoid mass, ulcerative lesion, or even a varicoid lesion. Radiologically, it is often difficult to distinguish adenocarcinoma from squamous cell. However, adenocarcinomas tend to involve longer segments of the esophagus than squamous cell carcinoma. Patients with adenocarcinoma arising in the background of Barrett's may also have associated hiatal hernias or gastroesophageal reflux. Distal adenocarcinomas also have a tendency to invade the gastric cardia or fundus. They can often manifest as polypoid or ulcerated masses in the stomach.

In image "A" the red arrows show mucosal invasion with ulceration, whereas the yellow arrow points out a stricture at the GE junction. In image "B", we can further see an irregular filling defect in the distal esophagus associated with adenocarcinoma.