Squamous carcinoma of the esophagus in patients with Barrett esophagus

Adenocarcinoma of the esophagus is a well-known complication of Barrett esophagus, especially in white men. We present three cases of squamous carcinoma of the esophagus in Barrett patients. All three patients were white men. None had a history of symptomatic gastroesophageal reflux or of Barrett esophagus, but all had substantial usage of alcoholic beverages and tobacco. All three tumors were located in squamous-lined mucosa above the Barrett mucosa. Columnar epithelial dysplasia was present in the Barrett mucosa of two of our patients, and the third patient had a squamous carcinoma of the pharynx. Squamous carcinoma represented 2% of Barrett-associated esophageal carcinomas at our institution in 1980 through 1986. Five additional cases were found in the literature, and all were also in white men. This demographic predominance stood in striking contrast to the 26% prevalence of white patients among those with squamous carcinoma of the esophagus at our institution (P less than 0.0002) and to the 50% prevalence of white men among our patients with Barrett esophagus (P less than 0.02). Two of the literature cases also had substantial alcohol and tobacco usage and had synchronous adenocarcinoma arising in Barrett mucosa. Our findings of a strikingly high prevalence of white men and of multifocal neoplastic changes in the upper aerodigestive tract suggest a pathogenetic relationship between squamous carcinoma of the esophagus and Barrett esophagus, possibly due to alcoholic beverage and tobacco usage. Endoscopic surveillance of Barrett patients for early detection of adenocarcinoma has been recommended; contemporaneous evaluation of the squamous-lined esophagus by biopsy and cytopathology may be advisable.(ABSTRACT TRUNCATED AT 250 WORDS)