Gueye Mamadou Ngoné, Diouf Gnagna, Dia Daouda, Boye Awa, Fall Thierno, Diémé Jean Louis, Ba Oumar, Mbengue Mouhamadou
Service d'Hépato-Gastroentérolgie, Hôpital Géneral de Grand Yoff, (HOGGY) Dakar, Sénégal.
Pan Afr Med J. 2017 Jan 18;26:23. doi: 10.11604/pamj.2017.26.23.9466. eCollection 2017.
Esophageal cancer is associated with poor prognosis. Its severity is linked to delayed diagnosis which is most often made once a cancer has metastasized, in Africa. Costal metastases are rare. We report a case of a 38-year old Senegalese patient with squamous cell carcinoma of the lower esophagus with lytic metastases to the ribs. Mrs. TD, aged 38, was admitted with painful swelling in right hemithorax associated with weight loss. The patient also reported mechanical dysphagia evolving during 4 months which had not motivated consultation. Clinical examination showed a poor general condition, a hard, sensitive swelling measuring 3 cm along its longer axis, located on the anterolateral surface of the right hemithorax at the level of the 5rib. Biological examinations showed normocytic normochromic anemia with hemoglobin level of 9.4 g/dl, non-specific biological inflammatory syndrome, and hypercalcemia (corrected calcium = 107 mg/l. Oesogastroduodenal endoscopy showed a ulcerative, budding, stenotic lesion 32 cm from the dental arches. Anatomopathological examination of the biopsies revealed moderately differentiated squamous cell carcinoma. In addition to oesophageal tumor, thoracoabdominal-pelvic computed tomography showed bone lysis involving the anterior arch of the 5 rib, carcinomatous pulmonary nodules and bilateral pleural effusion. Pleural fluid aspiration through an exploratory needle showed serohematic fluid and the cytological examination of this fluid objectified carcinomatous cells. The diagnosis of squamous cell carcinoma of the lower esophagus with rib, pleural and pulmonary metastases was retained and palliative treatment was initiated. The evolution was marked by the death of the patient 3 months after gastrostomy, within a context of respiratory distress. The originality of this observation is related to the atypical seat of metastases of this cancer of the esophagus as well as the risk factors of this tumor. Cancer of the esophagus in young adults is a major problem in Africa. The challenge is to determine its risk factors in order to prevent its occurrence.
食管癌预后较差。其严重程度与诊断延迟有关，在非洲，这种延迟诊断通常发生在癌症已经转移之后。肋骨转移很少见。我们报告一例38岁的塞内加尔患者，患有食管下段鳞状细胞癌并伴有肋骨溶骨性转移。TD夫人，38岁，因右半胸疼痛性肿胀并伴有体重减轻入院。患者还报告有进行性加重4个月的机械性吞咽困难，但未引起重视前来就诊。临床检查显示患者一般状况较差，右半胸前外侧表面第5肋骨水平有一个质地硬、有压痛、长轴为3厘米的肿胀。实验室检查显示正细胞正色素性贫血，血红蛋白水平为9.4克/分升，非特异性炎症综合征，以及高钙血症（校正钙 = 107毫克/升）。食管胃十二指肠内镜检查显示距齿状线32厘米处有一个溃疡性、隆起性、狭窄性病变。活检的解剖病理学检查显示为中分化鳞状细胞癌。除食管肿瘤外，胸腹部盆腔计算机断层扫描显示第5肋骨前弓骨质溶解、癌性肺结节和双侧胸腔积液。通过穿刺针抽取胸水显示为血性胸水，对该液体进行细胞学检查发现癌细胞。最终确诊为食管下段鳞状细胞癌伴肋骨、胸膜和肺转移，并开始进行姑息治疗。患者在胃造口术后3个月因呼吸窘迫死亡。该病例的独特之处在于这种食管癌转移的不典型部位以及该肿瘤的危险因素。非洲年轻成年人的食管癌是一个主要问题。挑战在于确定其危险因素以预防其发生。
