J Pathol Transl Med.  2024 Mar;58(2):81-86. 10.4132/jptm.2023.12.26.

A rare goblet cell adenocarcinoma arising from Barrett’s esophagus: the first reported case in the esophagus

• Oh CE
• Kim SE
• Oh SJ

• KMID: 2553475
• DOI: http://doi.org/10.4132/jptm.2023.12.26

Abstract

Goblet cell adenocarcinoma (GCA) is a rare and distinctive amphicrine tumor comprised of goblet-like mucinous cells and neuroendocrine cells. It is believed to originate from pluripotent stem cells located at the base of crypts. GCA predominantly arises from the appendix, with a few reported cases in extra-appendiceal locations such as the colorectum, small intestine, and stomach. In this case report, we present a unique instance of a 64-year-old male who initially received a diagnosis of neuroendocrine carcinoma in the distal esophagus based on biopsy but, following resection, was subsequently re-diagnosed with GCA arising from Barrett’s esophagus.

Keyword

Goblet cell adenocarcinoma; Goblet cell carcinoid; Extra-appendiceal

Figure

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  Fig. 1 (A) Gastroesophageal endoscopy revealed a mass with a central ulcer and irregular borders that almost completely encircled the esophageal lumen. (B) The biopsy showed sheets of tumor cells with hyperchromatic nuclei and minimal cytoplasm (right) along with normal esophageal squamous epithelium without dysplasia (left).

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  Fig. 2 (A) The gross examination of the resected tumor showed an ill-defined ulcerofungating firm mass in the distal esophagus, with the tip of the mass reaching the gastroesophageal junction. (B) Low magnification showed tumor cells penetrating the proper muscle layer and infiltrating the adventitia. (C) The gastroesophageal junction revealed esophageal squamous cells on the surface showing intestinal metaplasia (arrows), corresponding Barrett’s esophagus. At the base of the epithelium, a poorly differentiated single-file growth pattern of tumor cells was observed at the bottom with tumor glands with lumen observable at the top. (D) On high magnification in the low-grade tumor area, tumor cells exhibited a goblet cell morphology with intracytoplasmic mucin.

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  Fig. 3 (A) The tumor exhibited cribriform architecture and a single-file growth pattern at the lower and higher-grade regions, which contrasts with the more well-differentiated tumor components featuring glandular structures at the top. (B) Staining for synaptophysin highlights variable numbers of endocrine cells in immunohistochemical staining. (C) The Ki-67 labeling index was greater than 90%. (D) The tumor cells exhibited positive staining for luminal and intracytoplasmic mucin with alcian blue pH 2.5.

Reference

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