Case presentation A 62-year-old man developed progressive dysphagia and 2.5 kg weight over the preceding six months. He has had chronic gastroesophageal reflux disease for at least ten years and was taking an over-the-counter proton pump inhibitor. He has moderate hypertension that is well controlled with medication. He is moderately anemic (hemoglobin 11 g/dL), and because his anemia was unexplained and unexpected, he was referred to a gastroenterologist.
Examination Upper and lower endoscopies were performed. Colonoscopy was normal, but esophago-gastro-duodenoscopy showed a large mass located at the gastroesophageal junction (GEJ) extending to the proximal cardia. Several biopsies were performed, and the mass was identified as a poorly differentiated adenocarcinoma. A computed tomography (CT) scan revealed a GEJ mass, a 2-cm right lung mass, and 2 >1 cm liver masses.
