P2450 - A Rare Cause of Dysphagia: Polypoidal Esophageal Masses From Poorly Differentiated Thymic Cancer

Harleen K. Chela, MBBS, MD, Mary Mikhael, MD, Omer Basar, MD, Feng Yin, MD, PhD, Veysel Tahan, MD, Ebubekir Daglilar, MD
University of Missouri, Columbia, MO

Introduction: Solid food dysphagia can occur from intraluminal esophageal pathology or extrinsic compression may result in esophageal obstruction. The esophagus lies in the middle mediastinum, therefore it can be affected by diseases of surrounding structures. We present a case of dysphagia resulting from a large mediastinal mass and several intraluminal esophageal masses leading to esophageal obstruction.

Case Description/Methods: A 76-year-old female with a past medical history of hypothyroidism, breast cancer status post lumpectomy and radiation therapy presented with progressive dysphagia to solids for 10 days along with dyspnea. Labs were remarkable for leukocytosis. Chest CT showed multifocal intraluminal esophageal polyps/masses with large confluent middle mediastinal mass/confluent lymphadenopathy with the mass being inseparable from the left lateral esophageal wall, thyroid gland and also encasing the trachea. Esophagogram showed innumerable polypoidal expansile masses throughout the thoracic esophagus. Gastroenterology was consulted for tissue sampling of esophageal masses but it was deemed high risk of respiratory decompensation during endoscopy so interventional radiology consulted. Mediastinal mass was biopsied which revealed poorly differentiated carcinoma of thymic origin. Chemotherapy with carboplatin and paclitaxel was initiated during hospitalization and patient was to follow up with medical oncologist.

Discussion:
Differentials for dysphagia are broad and any form of internal and external masses may cause obstruction. Malignant growths in mediastinum can invade the esophagus and cause esophageal obstruction. Our patient had a thymic carcinoma that presented with dysphagia from both the invasion of the esophagus as well as polypoid growths in the esophagus.


Figure: Figure A: Esophagram showing multiple large, polypoidal expansile masses with scalloped margins.
Figure B: Chest CT showing multifocal intraluminal esophageal polyps/masses with large confluent middle mediastinal mass/confluent lymphadenopathy with the mass invading left lateral esophageal wall, thyroid gland and encasing the trachea.


Disclosures:
Harleen Chela indicated no relevant financial relationships.
Mary Mikhael indicated no relevant financial relationships.
Omer Basar indicated no relevant financial relationships.
Feng Yin indicated no relevant financial relationships.
Veysel Tahan indicated no relevant financial relationships.
Ebubekir Daglilar indicated no relevant financial relationships.


Harleen K. Chela, MBBS, MD, Mary Mikhael, MD, Omer Basar, MD, Feng Yin, MD, PhD, Veysel Tahan, MD, Ebubekir Daglilar, MD. P2450 - A Rare Cause of Dysphagia: Polypoidal Esophageal Masses From Poorly Differentiated Thymic Cancer, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.