A 56-year-old man comes to the physician due to several months of difficulty in swallowing. At first, meat would stick in his throat, and now he has difficulty swallowing all solid food and occasionally liquids. The patient coughs and sometimes aspirates food particles when eating. He has no shortness of breath, chest pain, or heartburn and has lost several pounds in the last 2 months. The patient was evaluated for persistent right ear pain 4 weeks ago, but no diagnosis could be made. His past medical history is significant for hypertension. He smokes 2 packs of cigarettes daily and consumes 6-8 bottles of beer on weekends. The patient is not sexually active. Lungs are clear to auscultation. Neck palpation shows no lymph node enlargement or thyromegaly. Endoscopy performed on this patient identifies an upper-esophageal mass with irregular contours that partially obstructs the lumen of the esophagus. Which of the following is the most likely histopathologic type of this tumor?

Question

A 56-year-old man comes to the physician due to several months of difficulty in swallowing.  At first, meat would stick in his throat, and now he has difficulty swallowing all solid food and occasionally liquids.  The patient coughs and sometimes aspirates food particles when eating.  He has no shortness of breath, chest pain, or heartburn and has lost several pounds in the last 2 months.  The patient was evaluated for persistent right ear pain 4 weeks ago, but no diagnosis could be made.  His past medical history is significant for hypertension.  He smokes 2 packs of cigarettes daily and consumes 6-8 bottles of beer on weekends.  The patient is not sexually active.  Lungs are clear to auscultation.  Neck palpation shows no lymph node enlargement or thyromegaly. Endoscopy performed on this patient identifies an upper-esophageal mass with irregular contours that partially obstructs the lumen of the esophagus.  Which of the following is the most likely histopathologic type of this tumor?

Quizplus · Accepted Answer

Explanation: The 2 main histopathologic types of esophageal carcinoma are adenocarcinoma (AC) and squamous cell carcinoma (SCC). The location in the esophagus of each type determines its incidence. AC is generally found in the distal to mid-esophagus and usually occurs in patients with chronic gastroesophageal reflux and Barrett's esophagus (Choice A). SCC is far more likely to cause upper-esophageal lesions, as seen in this patient. Chronic alcohol and tobacco use are risk factors for esophageal SCC and other squamous cell cancers of the head and neck. In recent years, the incidence of SCC has decreased as the incidence of AC has increased. (Choice B) Esophageal melanoma is much rarer than esophageal SCC or AC. (Choice D) Gastrointestinal stromal tumors are uncommon subendothelial malignancies. They occur primarily in the stomach and small intestine and are rare in the esophagus. Educational objective: Esophageal adenocarcinoma is found primarily in the lower esophagus and is associated with chronic gastroesophageal reflux and Barrett's esophagus. Squamous cell carcinoma is often seen in patients who use alcohol and tobacco chronically and is usually located in the upper esophagus. References: A survey of oesophageal cancer: pathology, stage and clinical presentation. (http://www.ncbi.nlm.nih.gov/pubmed/16480397)

A 56-Year-Old Man Comes to the Physician Due to Several