S4316 Poorly Differentiated Esophageal Adenocarcinoma in a 36-Year-Old Woman: A Case Report and Literature Review

Introduction: Esophageal cancer is the eighth most common cancer globally and the sixth leading cause of cancer-related death. Squamous cell carcinoma is the predominant subtype worldwide; however, in North America, Western Europe, and Australia, adenocarcinoma is more common. Esophageal cancer is nearly 3 times more frequent in men and 5 times more common in Caucasians than in African Americans, Asians, or Native Americans. The median age of diagnosis is 64–74, with only 3.2% of cases occurring under age 45. We present a case of poorly differentiated esophageal adenocarcinoma in a 36-year-old Hispanic woman. Case Description/Methods: A 36-year-old Hispanic woman with no past medical history presented to the emergency department with nausea, vomiting, and chest pain. She reported 1 month of solid food dysphagia, which progressed to include liquids over 2 weeks. She noted a 10-pound weight loss and denied tobacco, alcohol, nonsteroidal anti-inflammatory drug (NSAID) use, or family history of malignancy. Initial labs revealed hemoglobin 7.9 and hematocrit 27.6, with otherwise unremarkable labs. Computed tomography chest showed esophageal wall thickening and an abnormal gastroesophageal junction. Esophagogastroduodenoscopy revealed a near-obstructing distal esophageal mass and a mass at the gastroesophageal junction. Biopsies confirmed poorly differentiated adenocarcinoma. She was transferred to a tertiary center for stent placement and possible esophagogastrectomy with colonic interposition. Discussion: In the U.S., most esophageal adenocarcinomas are poorly differentiated at diagnosis, unlike squamous cell carcinomas, which are often moderately differentiated. Standard treatment includes chemoradiotherapy; surgery is performed in only 26.6% of cases, though more commonly in adenocarcinoma. One- and 5-year survival for esophageal adenocarcinoma is 54.4% and 23.4%, with a median survival of 15 months. Known risk factors include male gender, gastroesophageal reflux disease, Barrett’s esophagus, obesity, smoking, alcohol, NSAID use, and genetics. This case is notable for the patient’s lack of typical risk factors. Current screening is advised for patients with gastroesophageal reflux disease refractory to medical therapy.