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Case 280


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A 84-year-old male patient sought care for right cervical pain started 4 months ago associated with odynophagia. He progressively developed dysphagia for solid foods 2 months ago, and later for liquids as well. It has been reported a weight loss of 20 kg in the last 4 months. He is a long-time smoker and a former alcoholist. On the physical examination: pale color mucosa, cervical and supraclavicular lymph nodes enlarged on the right side, without phlogistic signs. Upper digestive endoscopy revealed an infiltrative and ulcerated lesion 20 cm from the upper dental arch. Computed tomography (CT) of the thorax and abdomen were also requested:

Considering the images, the EDA and the clinical history, indicate the alternative that presents the predominant tumor location and the most important risk factor(s) associated with this type of tumor:

a) Cervical esophageal tumor and Helicobacter pylori infection


b) Upper thoracic esophageal tumor and smoking and alcoholism


c) Middle thoracic esophageal tumor and gastroesophageal reflux disease


d) A conclusion could not be drawn from the data provided


Image Analysis

Images 1: Chest CT, axial sections (A and B), supracarinal level, without intravenous injection of iodinated contrast medium. Extensive parietal stenosing lesion infiltrating and invading the adjacent trachea in the upper thoracic esophagus (red arrows).


Images 2: Chest CT, axial cut, supracarinal (A) and infracarinal (B) levels, after intravenous injection of iodinated contrast medium, arterial phase. Extensive stenosing parietal lesion infiltrating and invading the adjacent trachea in the upper thoracic esophagus (red arrow). There is lymphadenomegaly in subcarinal site (blue arrow).


Images 3: Chest CT, coronal and sagittal reconstructions, carinal level, before (A) and after (B) intravenous injection of iodinated contrast medium. Stenosing infiltrative lesion invading the adjacent trachea in the upper/middle thoracic esophagus (red arrows). Lymphadenomegaly is present in subcarinal and upper-right paratracheal sites (blue arrows).


- Esophageal cancer is among the ten most frequent malignant neoplasm diagnosed in Brazil, with squamous cell carcinomas being the most prevalent histological type;
- The usual symptoms are progressive dysphagia and marked weight loss;
- Habits of smoking and alcoholism are important risk factors for esophageal squamous cell carcinoma. Gastroesophageal reflux disease is the main risk factor for adenocarcinoma;
- The diagnosis is made through upper digestive endoscopy with biopsy and histopathology examination;
- Regional lymph node metastases are early and frequent. The liver and lung are the most common sites of hematogenous metastases;
- In resectable tumors, surgical treatment is curative in 10% to 35% of cases.


- Saltzman, J. R.; Gibson, M.K. Diagnosis and staging of esophageal cancer. UpToDate 2017. [Cited 2017 Aug 12].
- Gibson, M.K. Epidemiology, pathobiology, and clinical manifestations of esophageal cancer. UpToDate. [Cited 2017 Aug 12].
- Chaber-Ciopinska A, Kiprian D, Kawecki A, Kaminski M, Surveillance of patients at high-risk of squamous cell esophageal cancer, Best Practice & Research Clinical Gastroenterology, 2016.
- Bogliolo, L.; Brasileiro Filho, G. Patologia. 7ªed. Rio de Janeiro: Guanabara Koogan, 2006.
- Rice, T. W. Esophageal cancer staging. Korean Journal of Thoracic and Cardiovascular Surgery 2015; 48(3): 157-163.


Joice Carneiro Dias Prodígios, 5th year medical student at Universidade Federal de Minas Gerais.
E-mail: joicecdp[at]


Professor Marco Antônio Gonçalves Rodrigues, Surgeon and Professor of the Department of Surgery at the Universidade Federal de Minas Gerais.


Bruno Campos, Ivan Debeus, Laio Paiva Silva, Professor José Nelson Mendes Vieira and Professor Viviane Parisotto.

Translated by

Ricardo Mazilão Silva, 5th year medical student at Universidade Federal de Minas Gerais.
E-mail: ricardodma789[at]

Test question

(Hospital Residency - Hospital Universitário Antônio Pedro / UFF - 2014) The best method for the staging of esophageal squamous cell carcinoma in the preoperative period, in relation to item T of the TNM classification, is:

a) Esophagogram


b) Chest computed tomography


c) Bronchoscopy


d) Ecoendoscopy


e) Esophageal endoscopy biopsy and histopathological study



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