Dysplastic gastroesophageal junction nodules - A precursor to junctional adenocarcinoma

Adenocarcinoma of the gastroesophageal junction is a disease rapidly increa sing in prevalence. The origin of these tumors is unclear. Barrett's esopha gus, gastric cardia lesions, and mucus glands of the distal esophagus have been implicated. This case report presents two cases of patients who had ch est pain leading to esophagogastroduodenoscopy. Both had small, benign-appe aring nodules at the gastroesophageal junction in the absence of Barrett's esophagus or gastric lesions. Biopsies revealed intestinal metaplasia with dysplasia in one patient and dysplasia of the mucus glands of the esophagus in the other. The first patient was followed for 8 months with serial biop sies, during which time the lesion became progressively more dysplastic, cu lminating in invasive cancer. These cases are presented to show that 1) ben ign-appearing gastroesophageal junction nodules may have malignant behavior , and 2) junctional cancer and high grade dysplasia can occur in the absenc e of Barrett's esophagus or gastric cardia lesions. Gastroesophageal juncti onal dysplasia/carcinoma may occur in small foci of intestinal metaplasia o r in the mucus glands of the distal esophagus. (Am J Gastroenterol 1999;94: 835-838. (C) 1999 by Am. Coll. of Gastroenterology).