Esophageal malignancies are commonly seen in the sixth, seventh, and eighth decades of life, and are rare at a young age and in children. 1 To date, only a few cases of esophageal carcinoma in children have been reported in the world literature.2 Epidemiological studies have shown that these esophageal malignancies are predominantly environment-produced, and require a long, latent period of carcinogenesis, thus accounting for its rarity in childhood. [3][4][5][6][7] There is no mention of etiological or environmental risk factors in the majority of these reported cases, and therefore, the pathogenesis of the condition is still unknown. A case of esophageal carcinoma in a 15-year-old girl is reported because of its rare incidence in this teenage group. A brief review of the literature is also provided. We believe that this is the first case of its kind to be reported from the Middle East. Case ReportA 15-year-old Sudanese female presented to the Gastroenterology Clinic of King Fahad Hospital, Medina, for progressively increasing dysphagia over a one-month period. The problem started with difficulty in swallowing solid food, and a feeling of food getting "stuck" in the retrosternal region. Initially, she could wash down the food with liquids. However, in a matter of only four weeks, she could not even swallow liquids without difficulty. Limitation in her oral intake resulted in weight loss. There was some chest discomfort, however, the swallowing was not painful. There was an associated feeling of ill health and lack of appetite. The patient had lived in Saudi Arabia for eight years, and had been in excellent health without any prior sickness. There had never been any previous swallowing problem. She denied having any chest pain, heartburn, regurgitation, nausea or vomiting, and there was no history of ingestion of any corrosive substance. She was not on any medications, such as antibiotics, NSAIDs, etc. She had no skin disease, had never smoked cigarettes or taken alcohol. She also denied drinking excessive "hot" coffee or tea, but admitted to occasionally taking soft drinks. There was no family history of esophageal problems or gastrointestinal malignancies, and there was no known familial or genetic disorder.Physical examination revealed a thinly built, apprehensive girl. There were no signs of chronic sickness. Her vital signs were stable, BP 110/80 mm Hg and pulse 70/minute. There was no icterus and skin was normal. There was no keratinization of her palms or soles to suggest tylosis. There were no signs to suggest nutritional deficiencies. The neck was supple, and there were no palpable lymph nodes. Examination of heart, lungs and abdomen were unremarkable. Liver was not enlarged and there was no ascites.Laboratory investigations showed hemoglobin of 14.5 g/dL, and normal WBC and platelet count. Urea, creatinine, electrolytes and liver enzymes, including alkaline phosphatase, were normal. Amylase was also normal, and chest x-ray was within normal limits.A barium swallow revealed an ulcerated mass about 7 cm ...
Desmoid tumors are soft-tissue neoplasms arising from fascial or musculo-aponeurotic structures. Most reported thoracic desmoid tumors originate from the chest wall. However, intrathoracic desmoid tumors are rare. We present a case of a 35-year-old male patient complaining of mild shortness of breath. The patient was diagnosed to have a huge intrathoracic desmoid tumor, which was successfully resected.
We appreciate the comments of Drs. Hoeffel and Fornes. The recognition of adenocarcinoma complicating Barrett's esophagus in young age is very important. We agree with them that this is probably the most important cause of malignant lesions in the esophagus in young age. In our article, we reported a case of squamous cell carcinoma and reviewed the literature regarding squamous cell carcinoma. As the incidence of adenocarcinoma in esophagus is increasing in adults, 3 we should have included these very important articles in the issue. There are many unanswered questions about Barrett's esophagus among children. Many factors may be responsible for the infrequent use of endoscopy in the diagnosis of reflux in children compared to adults, as a consequence, the true incidence of Barrett's esophagus is not known, although it is considered a "rare entity in children. Unfortunately, no clear guidelines have been established for this purpose.2 Once Barrett's esophagus is diagnosed, the other problem is that of follow-up. Regular surveillance is expensive, and at least the cost-effectiveness of the approach has been questioned. 3 The fact that about 10-20 esophageal biopsies may be needed during a single procedure, concerns about procedure time, cost and safety, may hinder widespread implementation of such surveillance programs.Induction of regression of Barrett's esophagus, especially the endoscopic ablative measures, has generated a lot of interest. In younger age patients, it may be an attractive method both to reduce the risk of malignancy and the cost of surveillance, but this still needs more proof. We agree with Hassal et al. 4 that young adults with adenocarcinoma have almost certainly had long-standing Barrett's esophagus from childhood. Early detection of Barrett's esophagus and surveillance may lead to prevention, early diagnosis and cure of adenocarcinoma of esophagus in children, and young adults.We would like to re-emphasis the importance of the need for clear-cut indication and more frequent use of EGD for reflux in children. We urge the development of guidelines on the follow-up of Barrett's esophagus, and increased awareness among pediatricians of this problem.
Case of a 27-year-old man who sustained penetrating chest injury caused by a metallic (iron) bar projecting from a pillar of a construction after he fell down from a height.
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