What's going on here!!!

This lesion is being removed from the distal oesophagus
WHAT IS THE LIKELY HISTOLOGY?

a) Hyperplastic polyp

You must be joking!

b) Adenomatous polyp

A gastric adenomatous polyp would surely now be malignant

c) Early malignant polyp

But it's arising from a malignant flat component!!!

d) Advanced gastric cancer

Absolutely!

explanation

Of course this is all very odd. Clearly this is an advanced cancer at the GOJ. What business do I have in 'attacking' this endoscopically?!   Actually, the elderly patient had completed a course of chemoradiotherapy (CRT) for a T2, N0 junctional adenocarcinoma some 30 months previously.

Now he has developed dysphagia and a CT confirmed a 2cm polyp at the gastro-oesophageal junction. Histology had shown 'at least IMca' and he was referred for consideration of an endoscopic resection.

Clearly this lesion can't be cured endoscopically. In fact, the elderly patient is not a candidate for surgery and therefore there is no cure at all. However, I was thinking that as the cancer is mainly polypoidal, perhaps if the nodule could be removed, his swallowing will improve and he will not need a stent and could be offered brachytherapy. Clearly this was all 'speculative' but I'm glad to say that 6 months later, the patient still has not developed any dysphagia and his now starting brachytherapy. No doubt a better outcome than could be offered by a stent?