病例报告:食管闭锁伴气管食管瘘病史的 13 岁男孩患食管鳞状细胞癌。

IF 2.1 3区 医学 Q2 PEDIATRICS Frontiers in Pediatrics Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI:10.3389/fped.2024.1438242
B Bernar, C Mayerhofer, T Fuchs, G Schweigmann, E Gassner, R Crazzolara, B Hetzer, U Klingkowski, A Zschocke, G Cortina
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引用次数: 0

摘要

成人食管癌是全球关注的健康问题。食管鳞状细胞癌(ESCC)约占食管癌的 90%。食管癌的预后仍然不容乐观,五年生存率低于 20%。食管癌通常发生在年龄较大的患者身上,目前还没有关于 18 岁以下患者食管闭锁后发生 ESCC 的报道。我们介绍了一例特殊的 ESCC 病例,患者是一名 13 岁男孩,曾患食道闭锁,并在婴儿期接受过矫正手术。手术后,患者失去了十多年的手术随访机会,随后因呼吸困难到我们的急诊科就诊,需要抗生素治疗和补充氧气。放射成像显示,患者右肺体积缩小并伴有支气管扩张,之前吻合处的食管狭窄,右肺邻近有脓肿。这些变化可能是由于食管到右肺的慢性瘘管造成的。最初植入支架的介入治疗没有取得持久的成功,为了防止进一步吸入右肺,患者接受了颈部食管造口术,并长期接受抗生素治疗。然而,4 个月后进行的胸部 CT 扫描显示,一个巨大的、呈进行性发展的椎管前肿块源自狭窄处下方的食管远端,压迫气管和右主支气管。患者病情迅速恶化,出现呼吸衰竭,需要静脉体外膜肺氧合。不幸的是,内窥镜活检发现了晚期 ESCC。由于没有合理的治疗方案,我们将治疗目标改为姑息治疗。本病例的关键信息是,在患有慢性感染的青少年中,脓肿有可能掩盖恶性转化。因此,对于有食道闭锁矫正手术史和慢性并发症的青少年,还应考虑食道鳞状细胞癌的可能性。
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Case Report: Esophageal squamous cell carcinoma in a 13-year-old boy with a history of esophageal atresia with tracheoesophageal fistula.

In adults, esophageal cancers are a global health concern. Esophageal squamous cell carcinoma (ESCC) accounts for approximately 90% of esophageal carcinomas. The prognosis of esophageal cancers remains dismal, with a five-year survival rate below 20%. It typically affects older patients, and for now, ESCC after esophageal atresia has not been reported in patients younger than 18 years. We present an exceptional case of an ESCC in a 13-year-old boy with a history of esophageal atresia and corrective surgery in infancy. After the surgery the patient was lost to surgical follow up for over ten years and then presented to our emergency department with respiratory distress requiring antibiotic therapy and supplemental oxygen. Radiologic imaging revealed a volume reduction of the right lung with bronchiectasis, as well as esophageal stenosis at the level of the previous anastomosis, with an adjacent abscess in the right lung. These changes may have arisen due to a chronic fistula from the esophagus to the right lung. Initial interventional therapy with a stent implantation had no lasting success and, in an effort to prevent further aspiration into the right lung, a cervical esophagus stoma was established, and the patient received prolonged antibiotic treatment. However, a thoracic CT scan performed 4 months later revealed a large, retrospectively progressive prevertebral mass originating from the distal portion of the esophagus below the stenosis, compressing the trachea and the right main bronchus. The patient's condition rapidly worsened and he developed respiratory failure, requiring veno-venous extracorporeal membrane oxygenation. Unfortunately, an endoscopic biopsy revealed an advanced ESCC. With no rational treatment options available, we changed the goals of care to a palliative setting. The key message of this case is that in adolescents with chronic infections, an abscess can potentially mask a malignant transformation. Therefore, in adolescents, with an history of corrective surgery for esophageal atresia and chronic complications, consideration should also be given to the possibility of squamous cell carcinoma of the esophagus.

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来源期刊
Frontiers in Pediatrics
Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
3.60
自引率
7.70%
发文量
2132
审稿时长
14 weeks
期刊介绍: Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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