title: Gastric adenocarinoma of the upper oesophagus: A literature review and case report.
abstract: BACKGROUND
  Ectopic gastric mucosa (EGM) otherwise termed gastric heterotopia or gastric inlet patch occurs in approximately 2.5% of the population. Adenocarcinoma uncommonly involves the upper oesophagus, rarely arising from gastric heterotopia or submucosal glands. Currently, there are 58 cases in the literature of oesophageal adenocarcinoma arising within areas of EGM. To date no paper has differentiated between gastric or intestinal type adenocarcinoma. This case, which describes adenocarcinoma arising within EGM, exhibited a different immunophenotype reminiscent of gastric type glands, in the absence of intestinal metaplasia. This case should be regarded as a different type of carcinoma, consistent with a non-Barrett's oesophagus-associated adenocarcinoma.
  
  
  METHODS
  A 63year old female presented with a three month history of progressive cervical dysphagia with no associated weight loss or general malaise. Gastroscopy revealed a suspicious lesion at the cricopharyngeus. Positron emission tomography demonstrated a metabolically active primary lesion without evidence of distant disease. The patient received neo-adjuvant chemotherapy followed by a three stage total oesophagectomy. Histology demonstrated a moderately differentiated adenocarcinoma with gastric immunophenotype and background changes of gastric heterotopia.
  
  
  CONCLUSIONS
  EGM is common but scarcely biopsied for evidence of dysplasia or adenocarcinoma. Whilst malignant progression is rare it is important that endoscopists are aware of the potential. Determining the exact type of adenocarcinoma may have implications for therapeutic approaches. Recognition of EGM at endoscopy may identify patients at greater risk of developing adenocarcinomas of the proximal oesophagus, however, this relationship and the necessity for screening requires more study.
authors.affiliation: Austin Health, Department of Upper GI Surgery, 145 Studley Road, Heidelberg 3084, Australia. Electronic address: griddiough@doctors.org.uk.
authors.forename: Georgina E
authors.initials: GE
authors.lastname: Riddiough
authors.affiliation: Austin Health, Department of Upper GI Surgery, 145 Studley Road, Heidelberg 3084, Australia.
authors.forename: Steve T
authors.initials: ST
authors.lastname: Hornby
authors.affiliation: Austin Health, Department of Pathology, 145 Studley Road, Heidelberg 3084, Australia.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Asadi
authors.affiliation: Head of Department of Upper GI Surgery, Austin Health, 145 Studley Road, Heidelberg 3084, Australia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aly
keywords: Adenocarcinoma; Ectopic gastric mucosa; Gastric inlet patch; Oeosphageal cancer