A 69-year-old man presents to the primary care physician with
dysphagia. The patient reports progressive
difficulty swallowing, now to the point where he has trouble tolerating liquids and sometimes
vomits after eating. The patient has a significant history of alcohol abuse, 50-pack-year smoking history, as well as
hypertension and
hyperlipidemia. Temperature is 37°C (98.6°F),
pulse is 68/min, respirations are 14/min and
blood pressure is 130/82 mmHg. Physical exam shows a thin male with bitemporal wasting and non-tender anterior cervical
lymphadenopathy. Oral and neck examination is unremarkable aside from poor dentition. Laboratory results are as follows:
| Laboratory value | Result |
| CBC, Serum |
| Hemoglobin | 11.2 g/dL |
| Hematocrit | 33.6% |
| Leukocyte count | 10,100 /mm3 |
| Platelet count | 149,000/mm3 |
| MCV | 72 fL |
| RDW | 11.5-14.5% |
| Iron Studies, Serum |
| Serum Iron | 90 μg/dL |
| Ferritin | Ferritin 170 ng/mL |
| Total iron binding capacity | 220 μg/dL |
A barium swallow study reveals an
esophageal mass that significantly narrows the lumen in the middle of the
esophagus. Which of the following pathologic features is most likely to be found on upper endoscopy?
