Adenomatous polyp arising in Barrett's esophagus

A 40-year-old woman with chronic symptoms of gastroesophageal reflux had a 1.5-cm filling defect in the distal esophagus on esophagogram. Endoscopy revealed distal esophagitis and, immediately above a hiatal hernia, a pedunculated polyp on a short stalk, which was removed by snare cautery. The polyp was an adenoma composed of tubular glands and covered by intestinal-type epithelium. Serial distal esophageal biopsies confirmed Barrett's metaplasia with areas of specialized columnar epithelium with goblet cells. These findings suggest that the full expression of neoplasia in Barrett's esophagus includes the development of adenomatous polyps as well as dysplasia and adenocarcinoma.