Pathology/Pathophysiology: GI neoplasia 1

Question 1

What are the etiologies of esophageal adenocarcinoma?

Answer 1

GERD
Scleroderma (rare)
ZE syndrome (rare)

Question 2

What is the epidemiology of esophageal adenocarcinoma?

Answer 2

50-60 yo
White > black
Obese, GERD, Barrett’s

Question 3

55 yo obese white male with a history of GERD and Barrett’s esophagus. Presents with dysphagia for solids→liquids, painful swallowing, and weight loss over the last 6 months.

Answer 3

Esophageal adenocarcinoma

Question 4

What is the pathogenesis of esophageal adenocarcinoma?

Answer 4

1. p53 mutation
2. loss/hypermethylation of p16/INK4a
3. Mutation of RB
4. Amplified cERB-B2, Cyclin D1, Cyclin E

Question 5

What are the key pathological features of esophageal adenocarcinoma?

Answer 5

Red areas = metastatic columnar epithelium
Pale areas = normal squamous epithelium

Goblet cells = intestinal metaplasia

Cytologic atypia = progression to malignancy

Question 6

What are the clinical manifestations of esophageal adenocarcinoma?

Answer 6

Dysphagia (solids –> liquids)
Weight loss/cachexia
Odynophagia
anemia

Question 7

How is esophageal adenocarcinoma diagnosed?

Answer 7

Barium x-ray - asymmetric narrowing
Endoscopy - image of mass
Chest CT / EUS - Look for spread and metastasis