Sridhar K S, Hussein A M, Patten J E
Department of Oncology, University of Miami School of Medicine, Jackson Memorial Hospital, Florida.
Am J Clin Oncol. 1990 Dec;13(6):527-31. doi: 10.1097/00000421-199012000-00016.
Although fistulae and hypercalcemia are rare at the time of diagnosis of esophageal carcinoma, they are not uncommon terminal events. Most fistulae communicate with the respiratory tract. Uncommon sites of fistulae due to esophageal carcinoma include extension to the aorta, pleura, pericardium, and mediastinum. We report a patient with a spontaneous pneumomediastinum discovered during radiologic staging of esophageal carcinoma. The symptoms were dysphagia, weight loss, and pneumonia. The patient had hypercalcemia refractory to conventional measures, another adverse prognostic factor. Cisplatin 100 mg/m2 was tolerated without acute toxicity and lowered the serum calcium to normal. However, the patient died due to respiratory failure 2 days after cisplatin therapy. To our knowledge, this is the first report of a spontaneous pneumomediastinum at presentation of an esophageal carcinoma. The course of our patient and a review of the literature suggest that fistulae and/or hypercalcemia are medical emergencies and are often fatal in esophageal carcinoma.
尽管瘘管形成和高钙血症在食管癌诊断时较为罕见，但它们作为终末期事件并不少见。大多数瘘管与呼吸道相通。食管癌导致的不常见瘘管部位包括延伸至主动脉、胸膜、心包和纵隔。我们报告了1例在食管癌影像学分期时发现的自发性纵隔气肿患者。症状为吞咽困难、体重减轻和肺炎。该患者有常规治疗难以控制的高钙血症，这是另一个不良预后因素。给予顺铂100mg/m²，患者耐受良好，无急性毒性反应，血清钙降至正常。然而，患者在顺铂治疗后2天因呼吸衰竭死亡。据我们所知，这是食管癌患者出现自发性纵隔气肿的首例报告。我们患者的病程及文献复习提示，瘘管形成和/或高钙血症是医疗急症，在食管癌中常是致命的。
