A 68-year-old woman with a personal history of interest reported smoking 20 cigarettes a day for 40 years, and as surgical interventions: cholecystectomy, hysterectomy and bilateral adnexectomy (due to uterine polymyomatosis).
The patient was studied two years ago in digestive consultations for moderate to solid dysphagia without other accompanying symptoms. Upper gastrointestinal endoscopy revealed a hiatal hernia with symptoms, which improved considerably with proton pump inhibitors.
Subsequently, during the review period in consultation, the patient developed severe epigastric pain lasting for a few months, and a second endoscopy was repeated which revealed a small cell-cell ulcerated carcinoma in the middle third of the esophagus.
Once these findings have been identified, further studies are performed on the patient, with the fundamental objective of finding the primary tumour (identifying in a pulmonary origin given the histological type of neoplasia) and staging the disease.
On physical examination, the patient had a conserved general condition, malaise, no findings of adenopathy, no relevant data on cardiopulmonary auscultation, with normal abdomen except the right subcostal scar and subumbilical continent level.
Analytically, there was no relevant change.
The gastroduodenal barium study showed a flat 5 cm ulcerated junction lesion measuring approximately 5 cm in length that slightly reduced the normal lumen of the same study.
1.
In the right iliac retroperitoneal cyst area, a neoplasm is observed at the level of the middle esophageal third, which causes a decrease in its lumen, with lymphadenopathies in the subcarinal area, left supraclavicular (1.5 cm); in the abdomen, adenopathies
No space-occupying lesion was found in the lungs.
Fiberoptic bronchoscopy showed no pathological findings.
A transthoracic needle aspiration was performed with positivity for oat-cell carcinoma, which could indicate pleural invasion.
1.
Endoscopy showed an ulcerated vegetating esophageal tumor extending from 30 to 35 cm and affecting 2/3 of its faces, but allowing the passage of the end.
Between 28 and 32 cm there was a well-defined retrocardiac mass without esophageal stenosis.
Multiple celiac adenopathies were found.
Biopsy of the lesion was reported as oat-cell small cell carcinoma.
Cranial CT showed no pathological findings.
Given the extension of the neoplasia, surgery is rejected, considering chemotherapy as the main therapeutic option and, at the end of the present work, it is considered the etoposide DC unit plus hospital treatment.
