OBJECTIVE

We described a clinical report involving a rare metastasis from early adenocarcinoma in Barrett’s esophagus from the mid-thoracic segment. The implantation pathway is determined to be the most likely mechanism of metastasis.

CASE REPORT

A 67-year-old male with cardiovascular pathology underwent esophagoscopy, revealing a 15-mm adenocarcinoma within the Barrett’s esophagus segment. Endosonographic findings indicated infiltration into the submucosal layer. A computed tomography revealed thickening of the lower third of the esophagus without lymph node involvement. Submucosal dissection of the adenocarcinoma was performed, histologically confirming T1b (sm2 = 1200 microns), lymphovascular invasion LVL (–), and a clear resection margin R0. A diagnosis of esophageal adenocarcinoma, staged as T1bN0M0, was established, with surgical intervention deemed contraindicated due to the high risk of postoperative mortality. The patient declined additional therapeutic modalities. A one-year follow-up CT exhibited no pathological changes. Subsequent esophagoscopy revealed a 10 mm adenocarcinoma in the mid-thoracic segment against an unaltered superficial stratified squamous epithelium. This lesion was subsequently excised via submucosal dissection, confirming histologically as T1b (sm1 — 50 microns), LVL (–), and R0.

CONCLUSION

This report presents an esophageal adenocarcinoma with implantation metastasis, providing insights into the nuances of endoscopic diagnosis and management approaches for patients with comorbidities.