Esophageal adenocarcinoma (T3N1)

Case contributed by Matt A. Morgan


Dysphagia to solids for a few months with 30 kg weight loss.

Patient Data

Age: 70 years
Gender: Male



Oesophagram with a polypoid mass in the distal esophagus, showing a 4 cm mass in the distal esophagus with coarse and fine lobulations and barium in its interstices.

Upper endoscopy


Image of the tumor on upper endoscopy: a nodular mass which occupied 50 - 74% of the circumference of the distal esophagus.

Endoscopic ultrasound

Radial endoscopic ultrasound images of the esophageal carcinoma. An irregular hypoechoic distal esophageal tumor invades the adventitia/subserosa: T3 tumor.

Para-esophageal lymph nodes were seen (third image), measuring up to 1 cm: N1 tumor.

Biopsies of the mass revealed moderately-differentiated esophageal adenocarcinoma.

Case Discussion

Esophageal carcinoma staging requires endoscopic ultrasound and biopsy for T1-T3 disease:

  • Tis: esophageal carcinoma in situ (pathologic diagnosis: no invasion into 
  • T1:  invasion into the lamina propria, muscularis mucosa, or submucosa
  • T2:  invasion into muscularis propria
  • T3:  invasion into the adventitia/subserosa

T4 disease can also be diagnosed with endoscopic ultrasound, but clear invasion of adjacent structures can often also be seen on cross-sectional imaging

  • T4: invasion into structures adjacent to the esophagus.

Nodal staging is based on the number of enlarged lymph nodes in the paraesophageal, perigastric, and celiac stations:

  • N1: 1-2 nodes
  • N2: 3-6 nodes
  • N3: >7 nodes

The TNM of esophageal squamous cell carcinoma and esophageal adenocarcinoma are staged differently.

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