Esophageal Carcinoma in a 15-Year-Old Girl: A Case Report and Review of the Literature

Abstract

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 ...

ESCC with Metastasis in the Young Age of Caustic Ingestion of Shortest Duration

“…Gastrointestinal malignancies are uncommon in children [6,11,12]. Esophageal carcinoma is a malignancy of adults mainly in the sixth or seventh decade of life [8,11,12].…”

“…Esophageal carcinoma is a malignancy of adults mainly in the sixth or seventh decade of life [8,11,12]. In the study by Nozoe et al, out of 259 subjects only 0.8% of the patients with ESCC were younger than 40 years [6].…”

“…In the study by Nozoe et al, out of 259 subjects only 0.8% of the patients with ESCC were younger than 40 years [6]. After searching the literature extensively, there appears to be only a few cases of esophageal carcinoma in children reported so far [1,12,13]. However, there are no case reports on esophageal squamous cell carcinoma due to caustic ingestion in childhood.…”

“…The reported incidence of esophageal carcinoma is about 3.5/100,000 population [12] but the incidence of carcinoma arising in patients with previous corrosive esophagitis is unknown. Most are squamous cell carcinomas and are more likely to arise in the proximal esophagus [13].…”

“…In general, there is no known familial predisposition to ESCC [7]. The only possible etiological factor linked to esophageal carcinoma has been the documentation of the carcinoma developing from lye ingestion [12]. There is however, a long latency period (12-41 years) between ingestion of lye and development of malignancy [4,[12][13][14].…”