A 50-year-old male smoker with gastroesophageal reflux disease undergoes surveillance endoscopy. Biopsy of the distal esophagus demonstrates salmon-colored mucosa with specialized intestinal metaplasia containing goblet cells (Barrett's esophagus). What major malignancy does Barrett's esophagus predispose to?

Answer and explanation

Correct answer: D. Esophageal Adenocarcinoma

  1. Step 1: Barrett's esophagus is a premalignant metaplastic change wherein the normal stratified squamous epithelium of the lower esophagus is replaced by specialized columnar intestinal-type epithelium containing goblet cells, driven by chronic acid and bile reflux.
  2. Step 2: It confers an approximately 30- to 40-fold increased risk of developing Esophageal Adenocarcinoma.
  3. Step 3: Squamous cell carcinoma of the esophagus is associated with tobacco, alcohol, and hot tea consumption, predominantly in the mid-esophagus.
Answer
Esophageal Adenocarcinoma.
Why not the others: 'Esophageal Squamous Cell Carcinoma' arises from squamous epithelium linked to smoking and alcohol; 'Gastric GIST' is a mesenchymal tumor of the stomach wall; 'Small cell carcinoma' is an aggressive neuroendocrine tumor.

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