Rutgers New Jersey Medical School Newark, NJ, United States
Amrita Chawla, MD1, Qi Yu, MD2, Sushil Ahlawat, MD1 1Rutgers New Jersey Medical School, Newark, NJ; 2Rutgers NJMS, Newark, NJ
Introduction: In the literature, transitional cell carcinoma (TCC) and dysphagia are rarely discussed. One case report discusses two cases of synchronous double cancer of the esophagus and urinary bladder. Another suggests a paraneoplastic neurological syndrome in which visual changes, glossal spasms, and dysphagia are associated with high-grade TCC.
Case Description/Methods: A 65-year-old man with a history of T1 high-grade TCC status post radical cystectomy and recurrent esophageal stricture presented with generalized weakness and dysphagia to solid foods. He had multiple endoscopies with dilation in the past and a barium swallow suggestive of a long segment of esophageal stricture. The most recent endoscopy showed an esophageal stricture due to extrinsic compression. An endoscopic ultrasound showed narrowing of the distal esophagus, but the scope could not pass through the stricture. Multiple enlarged lymph nodes were noted, but no mass was seen. Esophageal biopsy did not reveal intestinal metaplasia.
Fine needle aspiration of the lymph nodes showed metastatic poorly differentiated carcinoma. A thoracentesis and fluid analysis revealed that pleural effusion was positive for malignancy and metastatic poorly differentiated carcinoma. Neoplastic cells were positive for GATA-3, negative for TTF-1 and WT-1 supporting the diagnosis of metastatic carcinoma from the urinary bladder.
The patient underwent robotic video assisted thoracoscopic surgery with right lymph node dissection, right middle and lower lobe lung wedge biopsies, and right subcorinal node dissection. Lymph nodes and right lower lobe wedge resection showed metastatic poorly differentiated carcinoma in fragments of lymph nodes and in lymphvascular spaces. Right middle lobe wedge resection showed bronchiolitis obliterans-like changes. The tumor was positive for CK, GATA-3, and weakly positive for p63. CK20, androgen receptor, TFF-1, prostate specific antigen PAX-8 and p40 were negative. This profile was most compatible with metastatic carcinoma from a primary bladder cancer.
Discussion: Our case highlights the importance of maintaining a broad differential in patients with dysphagia with a history of malignancy. The patient was presumed to have an esophageal stricture. Other causes of dysphagia were not explored until he presented with persistent dysphagia despite multiple attempts of dilation. In patients with TCC, it is important to rule out rare, but possible causes of dysphagia relating to malignancy, metastasis and paraneoplastic syndromes.
Disclosures: Amrita Chawla indicated no relevant financial relationships. Qi Yu indicated no relevant financial relationships. Sushil Ahlawat indicated no relevant financial relationships.
Amrita Chawla, MD1, Qi Yu, MD2, Sushil Ahlawat, MD1. P1425 - An Unexpected Cause of Dysphagia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.