Case 10-2006 -- A 66-Year-Old Woman with Barrett's Esophagus with High-Grade Dysplasia

doi:10.1056/NEJMcpc059007

Volume 354:1403-1409		March 30, 2006		Number 13

Case 10-2006 — A 66-Year-Old Woman with Barrett's Esophagus with High-Grade Dysplasia

Norman S. Nishioka, M.D., and Gregory Y. Lauwers, M.D.

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Presentation of Case

A 66-year-old woman was referred to the gastroenterology clinicfor evaluation and management of Barrett's esophagus with high-gradedysplasia.

Seven months earlier, she had been seen at another hospitalbecause of rectal bleeding. She had occasional heartburn butno dysphagia, anorexia, abdominal pain, or weight loss. Colonoscopyrevealed a cecal polyp, which was resected. A histopathologicalexamination revealed a tubulovillous adenoma. Esophagogastroduodenoscopywith biopsy of the distal esophagus showed metaplastic glandularmucosa with goblet cells consistent with a diagnosis of Barrett'sesophagus, with high-grade dysplasia. Treatment with lansoprazole(60 mg daily) was started.

A follow-up endoscopic examination and esophageal biopsy . . . [Full Text of this Article]

Pathological Discussion

Dysplasia in Barrett's Esophagus

Discussion of Management

Prophylactic Esophagectomy

Observation

Mucosal Ablation

Photodynamic Therapy

Endoscopic Submucosal Resection

Anatomical Diagnosis

Source Information

From the Gastrointestinal Unit (N.S.N.) and the Department of Pathology (G.Y.L.), Massachusetts General Hospital; and the Departments of Medicine (N.S.N.) and Pathology (G.Y.L.), Harvard Medical School.