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P1244 - Chronic Cough Leads to Unexpected Diagnosis: Sarcomatoid Squamous Cell Carcinoma of the Proximal Esophagus

Monday, October 28

10:30 AM - 4:15 PM

Location: Exhibit Halls 3 and 4 (Street Level)

Presenting Author(s)

NS

Natasha Shah, MD

GI Fellow
Lutheran General Hospital
Chicago, IL

Natasha Shah, MD¹, Biana Modilevsky², Baseer Qazi, MD³, Kenneth D. Chi, MD³

¹Advocate Lutheran General Hospital, Park Ridge, IL; ²Midwestern University Chicago, College of Osteopathic Medicine, Downers Grove, IL; ³Lutheran General Hospital, Park Ridge, IL

Introduction: Sarcomatoid squamous cell carcinoma (SSCC) of the esophagus is a rare malignancy with an incidence of 2.0%. This entity was previously thought to be associated with an overall good prognosis compared to squamous cell carcinoma, however, recent studies revealed the disease to be of higher malignant potential. We report a case of a patient who was diagnosed with SSCC of the esophagus presenting with atypical symptoms.

Case Description/Methods: A 61 year old female with a 30 pack year smoking history presented with chronic cough and 30 pound weight loss over 3 months. She denied dysphagia. Vitals were significant for temperature of 39^oC and respiratory rate of 22. Serology revealed leukocytosis, microcytic anemia, and low albumin. Chest X-ray revealed right lobe opacification and antibiotic therapy was initiated. A computed tomography (CT) of the chest revealed a large fungating central cavitary mass in the right lung apex that appeared to be arising from or invading the proximal esophagus (A). Esophagogastroduodenoscopy (EGD) visualized a non-bloody, fungating mass nearly obstructing the proximal esophagus (B). Endoscopic ultrasound (EUS) revealed a 6.5cm hypoechoic mass that extended beyond the esophageal wall (C). Multiple hyperechoic liver lesions greater than 1cm in diameter were found, raising suspicion for metastases. Forceps biopsy of the esophageal mass showed spindle shaped cells and cytokeratin positive epithelial cells consistent with SSCC. Positron emission tomography (PET/CT) scan revealed a right upper lobe necrotic lung mass and findings suggestive of metastases to bone and pancreas. Due to the extent of disease, she was neither a surgical candidate nor stable enough for chemotherapy and therefore, underwent palliative care. The patient expired shortly after her diagnosis.

Discussion: We highlight a rare pathology and its radiographic and endoscopic images in a patient who did not present with the typical symptom of dysphagia. Only 10% of these cases consist of asymptomatic patients. Therapy includes esophagectomy versus chemoradiotherapy depending on the extent of the disease. At this time, due to the rarity of the disease and the complexity of its diagnosis on biopsy, only a handful of case reports have identified patients with this etiology and very few large cohort studies have been done to further assess overall prognosis and survival rates.

Figure A. Computed tomography (CT) of the chest revealed a mass in the right lung apex that appeared to be arising from or invading the proximal esophagus

Figure B. Esophagogastroduodenoscopy (EGD) visualized a non-bloody, fungating mass nearly obstructing the proximal esophagus

Figure C. Endoscopic ultrasound (EUS) revealed a 6.5cm hypoechoic mass that extended beyond the esophageal wall

Disclosures:

Natasha Shah indicated no relevant financial relationships.

Biana Modilevsky indicated no relevant financial relationships.

Baseer Qazi indicated no relevant financial relationships.

Kenneth Chi indicated no relevant financial relationships.

Citation: Natasha Shah, MD; Biana Modilevsky; Baseer Qazi, MD; Kenneth D. Chi, MD. P1244 - CHRONIC COUGH LEADS TO UNEXPECTED DIAGNOSIS: SARCOMATOID SQUAMOUS CELL CARCINOMA OF THE PROXIMAL ESOPHAGUS. Program No. P1244. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.