Esophageal Squamous Cell Carcinoma of the Distal Esophagus and Gastroesophageal Junction

Abstract

The following case demonstrates a rare site of esophageal squamous cell carcinoma, the distal esophagus and gastroesophageal junction. A 51 year-old-male presented to the emergency department with a three week history of dysphagia. The patient's past medical history was most notable for a sixty pack-year smoking history. He reported progressive dysphagia to both solids and liquids over the time period, as well as a “sticking” sensation in his chest with PO intake. On the day of presentation, he experienced an episode of a choking sensation after drinking water, followed by oral and nasal regurgitation. He reported an associated unintentional 15-pound weight loss over a six-month period. An EGD performed showed a large, ulcerated circumferential mass with friable mucosa extending from the distal esophagus to the gastroesophageal junction. There were no stigmata of recent bleeding in the lower third of the esophagus. The mass partially obstructed the esopahgeal lumen. Biopsies demonstrated squamous cell carcinoma of each sampled portion of this mass. Following staging workup, the patient was determined to have stage 3 esophageal squamous cell carcinoma and was initiated on curative intent chemoradiation. The US incidence of esophageal squamous cell carcinoma has decreased over the past three decades, while the incidence of esophageal adenocarcinoma has increased considerably. Known risk factors for esophageal squamous cell carcinoma include tobacco and alcohol use with dysphagia and weight loss being frequent presenting symptoms. Squamous cell carcinoma is most often located in the proximal two thirds of the esophagus, with adenocarcinoma being more common in the distal region surrounding the gastroesophageal junction. While this patient's tobacco use is a common risk factor and his symptoms of dysphagia and weight loss are consistent with presenting symptoms, this case illustrates an uncommon location for esophageal squamous cell carcinoma, the distal esophagus and gastroesophageal junction.