S3577 A Case of Early Adenocarcinoma of Gastric Cardia

Abstract

INTRODUCTION: Gastric cancer can be classified as cardia and non-cardia subtypes according to the anatomic site. One of the main etiological factors involved in the development of both cardia cancers and Esophageal adenocarcinomas (EACs) is central obesity. We discuss a case of a patient who presented with hematochezia and was diagnosed with gastric cardia adenocarcinoma. CASE DESCRIPTION/METHODS: A 60 year-old obese African American male was admitted for hematochezia and loose stools. The patient started having the symptoms 3 days before presentation after eating at a restaurant. His symptoms resolved a day after the admission. Review of symptoms was positive for acid reflux. Family and surgical history were insignificant. He drank socially and had 30 pack-year smoking history. He denied taking any medications for acid reflux and any endoscopic intervention in the past. His vitals were acceptable and physical examination including digital rectal exam was unremarkable. Hemoglobin was 13 and the rest of the blood tests, stool studies were within normal limits. Due to a history of acid reflux and hematochezia, the patient underwent endoscopic intervention. Diverticulosis was noted on colonoscopy. A 8mm nodule was noted in the cardia and biopsy was suggestive of focal high-grade dysplasia. The patient underwent EUS and Endoscopic-submucosal dissection (ESD). Histopathological findings were suggestive of early, well-differentiated, intramucosal adenocarcinoma, with extensive high-grade dysplasia. Immunostains were suggestive of infiltrating single or small groups of tumor cells (AE1, AE3); negative for vascular (CD31), lymphatic (D240), or submucosal invasion (desmin). DISCUSSION: Gastric cardia cancer may develop in patients with chronic GERD without H. pylori infection. High volume reflux content including bile acids play a major role in carcinogenesis. Our patient was a chronic smoker and never sought treatment for acid reflux. In addition to imaging studies, EUS is used for locoregional staging. ESD should be carefully considered after comprehensive pretreatment workup and staging. The common complications of ESD are pain, bleeding, and perforation. Bleeding is the most common complication. Stricture formation is common if ESD is performed at cardia as in our case. The incidence of cardia cancers and esophageal adenocarcinoma (EAC) continues to increase with chronic GERD and obesity being a common risk factor. Early endoscopic intervention can be diagnostic and curative.Figure 1Figure 2Figure 3.: Post-Endoscopic submucosal dissection.