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Background  We report on a female patient who underwent primary radical resection for a stage 2B Her-2-positive Barrett’s-type esophageal adenocarcinoma (EAC). Despite Her-2 targeted therapy, her disease recurred and required repeated metastectomies.    Case presentation  Digital cell sorting and targeted sequencing of cancer sub-clones from EAC and metastases revealed a completely mutated  TP53 , whereas the sorted stromal cells were wild-type. Her-2 amplification was significantly lower in the metastases when the patient became therapy-resistant.    Conclusions  The mechanism of therapy resistance illustrated by this case could only be detected through accurate analysis of tumor sub-populations.  Investigating tumor sub-populations of recurrent disease is important for adjusting therapy in recurrent EAC.    Electronic supplementary material  The online version of this article (10.1186/s12885-018-4789-4) contains supplementary material, which is available to authorized users.

bmc cancer

Genomic profiles of primary and metastatic esophageal adenocarcinoma identified via digital sorting of pure cell populations: results from a case report