1781 Esophageal Squamous Cell Carcinoma Masquerading as Neuropathic Pain

Abstract

INTRODUCTION: The most common symptoms for esophageal carcinoma are dysphagia and odynophagia, though most are asymptomatic. We describe a case of upper esophageal squamous cell carcinoma masquerading as subphrenic neuropathic pain, not previously described in the literature. CASE DESCRIPTION/METHODS: A 67 year-old male with a past medical history of cholecystitis status post cholecystectomy, hepatic steatosis, acid reflux, hyperlipidemia, and 5-pack year tobacco history presented with 2 years of neuropathic subphrenic pain that radiated below the subcostal margins. The ingestion of solids and liquids triggered the pain, lasting for 1-2 seconds. The pain did not respond to viscous lidocaine or proton pump inhibitors. EGD two years prior revealed a nodular area of mucosa suspicious for esophageal squamous papilloma. His BMI was 29.6 and physical examination was otherwise unremarkable. He had normal peristalsis on esophageal manometry. EGD revealed a nodular mucosal patch in the upper third of the esophagus. Biopsies reproduced the patient’s sharp neuropathic pain. Pathology revealed ulcerated high-grade squamous dysplasia with a focus suspicious for stromal invasion. The stomach demonstrated segmental moderate mucosal changes characterized by atrophy, discoloration, and altered texture along the greater curvature of the gastric body with chronic inactive gastritis with extensive intestinal metaplasia on biopsy. H. pylori testing was negative.Endoscopic ultrasound demonstrated a confirmed a 4cm superficial lesion involving 1/3rd of the lumen. Endoscopic submucosal dissection was performed and pathology demonstrated a T1a squamous cell carcinoma with infiltration into the lamina propria and a focal tongue of tumor in the superficial muscularis mucosa. His pain resolved following resection. DISCUSSION: Esophageal squamous cell carcinoma masquerading as neuropathic pain is highly unusual. The mechanism behind this presentation remains unclear. The squamous papilloma visualized on prior EGD was a risk factor for the development of carcinoma. This case illustrates that squamous cell carcinoma can present with neuropathic pain, a symptom with swallowing that warrants further investigation.