A 56-year-old male smoker, diagnosed fifteen years before achalasia, underwent endoscopic dilatation at that time, without treatment or subsequent follow-up by decision of the patient.
She was admitted for a 3-month history of progressive dysphagia to solids and liquids and weight loss.
An oral endoscopy was performed aiming at oesophagus with abundant fluid remnants, septal walls, sigmoid morphology and mucosa with a cracked appearance, friable cardia and punctiform cardia, with resistance to the passage justifying pseudocal lesions.
At 22 cm of arcade of epidermoid carcinoma, a deep mucosal lesion was observed, covered with fibrin and plug, with a large histology covering the half of the circumference, with a moderate malignant aspect that was biopsied.
The CT study showed markedly dilated esophagus and parietal thickening of the proximal third of the esophagus with probable isolation of the posterior tracheal wall, which was confirmed by bronchoscopy.
With the diagnosis of moderately differentiated squamous cell carcinoma of the esophagus stage III with tracheal intubation, systemic chemotherapy was initiated according to the cisplatin-/5-fluouracil regimen.
The patient suffers a picture compatible with bronchoaspiration, presenting progressive clinical deterioration, finally resulting in death seven days after the beginning of the treatment, being related to associated esophageal perforation, bronchopneumonia and bronchopneumonia.
