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• W4387248927 abstract "SESSION TITLE: Lung Cancer Case Report Posters 5 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Esophageal strictures are characterized as benign or malignant, the latter being prone to rapid development. Primary diagnostic modalities are EGD, EUS and barium swallow study. We present a case of rapidly progressive esophageal stricture in the setting of lung adenocarcinoma in order to discuss suitable diagnostic workup to provide favorable outcomes. CASE PRESENTATION: This is a 58 year old female who presented to her primary care provider in October 2022 with complaints of a productive cough, unintentional weight loss, and dyspnea for 6 - 8 weeks. A CT scan demonstrated a dense, mass-like opacity in the right middle lobe, moderate right pleural effusion, thickened appearance of the mid/distal esophagus, and lytic/sclerotic osseous lesions throughout the spine and ribs. At her oncologist's office in early December 2022, the patient also complained of dysphagia and a plan was made to obtain a PET scan, CT guided thoracentesis, and bronchoscopy. The PET scan revealed widespread, innumerable bone metastasis and hypermetabolic wall thickening of the esophagus, suspicious for malignancy. The patient was seen in the GI clinic a month later where she underwent an EGD with biopsy. The procedure showed signs of extrinsic esophageal compression and a food bolus impaction. Pathology results showed esophageal candidiasis and no malignancy. Given these findings, the patient was immediately sent to the ED and admitted for poor PO intake and further dysphagia workup. She was treated with diflucan. Given her signs of extrinsic compression on EGD, there was concern of the pleural effusion causing dysphagia. Pulmonology was consulted and the patient underwent thoracentesis and PleurX catheter placement with 2.8L fluid removal. Fluid studies were consistent with stage IV metastatic pulmonary adenocarcinoma. Despite the fluid removal, the dysphagia did not improve. Imaging studies were negative for a mass, leading to the most likely etiology of tumor metastasis to the esophageal tissue. GI attempted to obtain repeat EGD and EUS. The EUS was aborted as the esophageal stricture had become so severe that the scope was unable to be passed through. The patient instead underwent palliative esophageal stenting. Ultimately a PEG tube was placed to optimize nutrition. She was discharged home with outpatient follow-up for palliative chemotherapy. Outpatient bronchoscopy was not done. The patient passed away within 4 weeks of discharge. DISCUSSION: Malignant strictures are often caused by primary esophageal or metastatic cancers. Guidelines suggest quick intervention with stenting or brachytherapy to preserve PO intake. Our literature review has yielded similar case reports where patients had negative EGD biopsy results but positive EUS biopsies for malignancy. Our patient was unable to tolerate EUS due to the rapid progression of the stricture. CONCLUSIONS: Due to the propensity for rapid progression of malignant strictures, timely diagnosis and biopsy are essential. Our literature review and case suggest obtaining simultaneous EGD and EUS with bronchoscopy or EBUS/bronchoscopy for timely diagnosis and intervention for prevention of symptomatic deterioration and improvement in quality of life. REFERENCE #1: Wang, CY., Xu, G., Gao, C. et al. Esophageal metastases from primary lung cancer: a case report. J Med Case Reports 15, 265 (2021). REFERENCE #2: Kimura, Shohei MD1; Onishi, Iichiroh MD, PhD2; Kobayashi, Masanori MD, PhD1,3. A Rare Case of Esophageal Metastasis of Invasive Mucinous Adenocarcinoma of the Lung. ACG Case Reports Journal 9(8):p e00857, August 2022. | DOI: 10.14309/crj.0000000000000857 REFERENCE #3: Antler, A.S., Ough, Y., Pitchumoni, C.S., Davidian, M. and Thelmo, W. (1982), Gastrointestinal metastases from malignant tumors of the lung. Cancer, 49: 170-172. https://doi.org/10.1002/1097-0142(19820101)49:1<_x0031_70:_x003a_AID-CNCR2820490134>3.0.CO;2-A DISCLOSURES: No relevant relationships by Tejaswini Addanki No relevant relationships by Omar Akhter No relevant relationships by Ashirf Al Ghanoudi No relevant relationships by Adnan Ansari No relevant relationships by Rinky Desai No relevant relationships by Tejasvini Kapa No relevant relationships by Hosam Khayal No relevant relationships by Areeba Marrium No relevant relationships by Anum Qadri No relevant relationships by Jeffrey Sam No relevant relationships by Ravi Sundaram" @default.
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• W4387248927 date "2023-10-01" @default.
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• W4387248927 title "RAPID DEVELOPMENT OF ESOPHAGEAL STRICTURE IN THE SETTING OF LUNG ADENOCARCINOMA" @default.
• W4387248927 doi "https://doi.org/10.1016/j.chest.2023.07.2821" @default.
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