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Barrett’s carcinoma at the Z-line

Prof. Dr. Mario Anders

Vivantes Wenckebach Klinikum, Berlin

Patient history

Presentation, for a second opinion, of a 47-year-old male patient with multiple morbidities, in whom an early Barrett’s carcinoma had previously been removed using endoscopic mucosal resection (EMR) at an external hospital (pT1b, pL0, pL0, pV0, pR1 also at base). Despite the R1 situation at the base and the patient’s age, a surgical intervention had not been carried out due to the patient’s poor general condition and concomitant conditions.

Findings before EMR, with a clearly polypoid lesion at the Z-line.
Findings during the EMR previously carried out at another hospital, with insufficient ablation at the base already visible macroscopically.

Endoscopic images

There was an initially noticeable bulge at the Z-line; on closer examination, an irregular central area was then seen, with a suspicion of undermining growth under the squamous epithelium.

Endoscopic therapy

The planned endoscopic resection starts with marking of the lesion with a sufficient safety margin.

Status post endoscopic submucosal dissection (ESD), including all markings.

Histology

Submucosal invasion by a T1b carcinoma (sm1, max. 160 µm), L0, V0, R0, G1, with growth partly undermining the squamous epithelium.

Further procedure

Presentation of the case at the interdisciplinary tumor board. Surgery was not planned, due to the patient’s multiple morbidities. Follow-up (with endoscopy and CT).

Check-up, 6 months after ESD: No macroscopic or histological signs of recurrence; no suspicious lymph nodes on the CT.

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