Esophageal submucosal gland duct adenoma: a case report and pooled analysis of demographic differences between...

Esophageal submucosal gland duct adenoma (ESGDA) is an exceptionally rare benign tumor. Classic teaching suggests a predilection for the upper and mid esophagus. This study reports a new case and performs a comparative literature analysis to test for potential geographic variations.

A 61-year-old Asian male was found to have a 1.6 cm submucosal tumor in the distal esophagus during a routine check-up. The lesion was successfully resected via endoscopic submucosal dissection (ESD), with pathological confirmation of ESGDA.

We conducted a pooled analysis of 20 well-documented ESGDA cases from the literature. Cases were stratified into an Eastern cohort (n=10) and a Western cohort (n=10) based on the first author's affiliation. Demographic and tumor characteristics were systematically compared. Given the small sample size, Fisher's exact test was applied for categorical variable comparisons.

Striking differences were observed. The Eastern cohort exhibited a profound male predominance (9:1 male-to-female ratio), whereas the Western cohort had a balanced sex distribution (1:1). Fisher's exact test for this comparison yielded a two-sided P value of 0.141. Tumor location also differed dramatically: 100% of Eastern cases were located in the distal esophagus/gastroesophageal junction, compared to only 40% of Western cases, with 60% of Western cases found in the mid or upper esophagus, a pattern not seen in the Eastern cohort (Fisher's exact test, P = 0.011). Mean age and tumor size were similar between groups.

The clinical presentation of ESGDA demonstrates notable geographic patterns. In this analysis, Eastern cases presented exclusively in the distal esophagus with a strong male predominance, while Western cases showed a broader anatomical distribution and a balanced sex ratio. These descriptive findings suggest potential population-specific differences. Clinicians should be aware of these patterns, and future studies with larger sample sizes are warranted for confirmation.