Rookies Quiz 2


A 60 year old male, a chronic smoker, presents with the chief complaints of dysphagia to solids and loss of weight of 3 months duration.
What examination has been performed ?
What is your diagnosis ?

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Diagnosis
Barium swallow reveals an irregular stricture in the mid esophagus, OGD scopy revealed an irregular circumferential growth (squamous cell carcinoma on biopsy).

Discussion
Specific disorders and predisposing factors listed below have been associated with an increasing prevalence of esophageal malignancy:
Achalasia
Asbestosis
Barrett esophagus
Celiac disease
Ionizing Radiation
Lye strictures
Plummer Vinson Syndrome
Tylosis palmaris or plantaris
Tannins, alcohol, tobacco exposure

Squamous cell carcinoma accounts for nearly 95% of the malignant lesions of the esophagus. Cancer of the esophagus is 3-4 times more common in males rather than females, and twice as common in non-whites than whites. Adenocarcinomas are less common, usually in the lower third, and most of them arise from metastatic columnar epithelium of Barrett's esophagus.

Barium Findings
Most frequent presentation is annular carcinoma or the apple-core lesion, which has sharp overhanging edges both proximally and distally. Fistulas to the trachea, bronchi and into the mediastinum are not uncommon, and may develop specially during therapy as tumor necrosis occurs. Polypoidal carcinomas which are less common are seen as a polypoidal filling defect with a broad base.
Verrucous squamous cell carcinoma is a rare locally invasive tumor with a lobulated surface, while varicoid esophageal carcinomas appear as thickened, tortuous, nodular, fold-like that resemble esophageal varices, this pattern is seen due to a combination of submucosal spread and polypoidal nature of the lesion.
OGD scopy, CT scan of chest and abdomen are further investigations performed to stage esophageal carcinomas.