Adenocarcinoma of the Gastroesophageal Junction Masquerading as Mallory-Weiss Syndrome

Mallory-Weiss syndrome (MWS) is a relatively uncommon cause of upper gastrointestinal bleeding. While most cases can be managed conservatively, frequent transfusions or endoscopic hemostasis may be required in some cases. A 74-year-old man presented with hematemesis triggered by coughing. He had a history of violent chronic cough due to chronic obstructive pulmonary disease and was placed on aspirin and warfarin after multiple percutaneous coronary interventions and aortic valve replacement. Emergency esophagogastroduodenoscopy (EGD) revealed a mucosal tear in the gastroesophageal junction (GEJ) consistent with MWS which was treated with hemoclips. No tumor was seen at the bleeding site on follow-up EGD. Hematemesis after coughing was repeatedly seen 2–5 months after the initial episode. Twelve months after the initial episode, the patient was admitted for pneumonia, heart failure, and tarry stools. Emergent EGD revealed a 30-mm mass at the GEJ, diagnosed as poorly differentiated adenocarcinoma on biopsy. Computed tomography revealed multiple enlarged lymph nodes consistent with metastases. The patient died 1 week later due to unrelated acute respiratory distress syndrome. Endoscopists should be aware that cancer of the GEJ may masquerade as repeated episodes of MWS.