Bernar B, Mayerhofer C, Fuchs T, Schweigmann G, Gassner E, Crazzolara R, Hetzer B, Klingkowski U, Zschocke A, Cortina G
Department of Anesthesia and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria.
Front Pediatr. 2024 Oct 11;12:1438242. doi: 10.3389/fped.2024.1438242. eCollection 2024.
In adults, esophageal cancers are a global health concern. Esophageal squamous cell carcinoma (ESCC) accounts for approximately 90% of esophageal carcinomas. The prognosis of esophageal cancers remains dismal, with a five-year survival rate below 20%. It typically affects older patients, and for now, ESCC after esophageal atresia has not been reported in patients younger than 18 years. We present an exceptional case of an ESCC in a 13-year-old boy with a history of esophageal atresia and corrective surgery in infancy. After the surgery the patient was lost to surgical follow up for over ten years and then presented to our emergency department with respiratory distress requiring antibiotic therapy and supplemental oxygen. Radiologic imaging revealed a volume reduction of the right lung with bronchiectasis, as well as esophageal stenosis at the level of the previous anastomosis, with an adjacent abscess in the right lung. These changes may have arisen due to a chronic fistula from the esophagus to the right lung. Initial interventional therapy with a stent implantation had no lasting success and, in an effort to prevent further aspiration into the right lung, a cervical esophagus stoma was established, and the patient received prolonged antibiotic treatment. However, a thoracic CT scan performed 4 months later revealed a large, retrospectively progressive prevertebral mass originating from the distal portion of the esophagus below the stenosis, compressing the trachea and the right main bronchus. The patient's condition rapidly worsened and he developed respiratory failure, requiring veno-venous extracorporeal membrane oxygenation. Unfortunately, an endoscopic biopsy revealed an advanced ESCC. With no rational treatment options available, we changed the goals of care to a palliative setting. The key message of this case is that in adolescents with chronic infections, an abscess can potentially mask a malignant transformation. Therefore, in adolescents, with an history of corrective surgery for esophageal atresia and chronic complications, consideration should also be given to the possibility of squamous cell carcinoma of the esophagus.
在成年人中，食管癌是一个全球关注的健康问题。食管鳞状细胞癌（ESCC）约占食管癌的90%。食管癌的预后仍然很差，五年生存率低于20%。它通常影响老年患者，目前，18岁以下患有食管闭锁的患者中尚未有ESCC的报道。我们报告了一例特殊病例，一名13岁男孩患有ESCC，他在婴儿期有食管闭锁病史并接受了矫正手术。手术后，患者失访手术超过十年，随后因呼吸窘迫到我们的急诊科就诊，需要抗生素治疗和补充氧气。放射影像学检查显示右肺体积缩小伴支气管扩张，以及先前吻合部位的食管狭窄，右肺有相邻脓肿。这些变化可能是由于食管至右肺的慢性瘘管引起的。最初的支架植入介入治疗没有取得持久成功，为了防止进一步误吸到右肺，建立了颈段食管造口，患者接受了长期抗生素治疗。然而，4个月后进行的胸部CT扫描显示，一个巨大的、回顾性进展的椎体前肿块起源于狭窄下方食管的远端，压迫气管和右主支气管。患者病情迅速恶化，出现呼吸衰竭，需要静脉-静脉体外膜肺氧合。不幸的是，内镜活检显示为晚期ESCC。由于没有合理的治疗选择，我们将护理目标改为姑息治疗。这个病例的关键信息是，在患有慢性感染的青少年中，脓肿可能会掩盖恶性转化。因此，对于有食管闭锁矫正手术史和慢性并发症的青少年，也应考虑食管鳞状细胞癌的可能性。
