A case report of unusual presentation of esophageal cancer

Esophageal cancer occurs in only 1% of all cancers in USA. There are two major histological types of esophageal cancers: in 90% it is esophageal squamous cell cancer and in 5% esophageal adenocarcinoma (EAC). EAC most often localized in the distal esophagus. Presenting symptoms are dysphagia, weight loss and chest pain. EAC is more common in men than women, with mean age 70. EAC has one of the highest mortalities. Case report: In mid-October 2020, a 40-year-old female with a BMI of 18 kg/m2 turned to a family doctor with complaints of sore throat, dry cough, hoarseness, and decreased appetite. Despite course of antibiotics, the cough continued to worsen, and shortness of breath appeared. She was hospitalized, SARS-CoV-2 test was negative. CT of the chest revealed abnormal thickening of esophagus and metastasis in lungs. She denied any medical history of gastroesophageal reflux disease or esophagitis. She smoked for 20 years and had alcohol abuse in the past. She left the hospital. At the end of November 2020, she was hospitalized again with severe shortness of breath. In bronchoscopy the tracheal obstruction was 70% and right bronchus was completely obstructed with tumor mass. A permanent tracheostomy tube was inserted to relieve symptoms. Esophagogastroduodenoscopy revealed endoscopically impermeable formation of esophagus, localized at the border between the upper and middle third of esophagus, 15cm from the front teeth. Histopathology of biopsies concluded: low-grade (Grade III) adenocarcinoma with necrosis. The patient was discharged from the hospital at her own request. Exitus letalis on 10.12.20. Respiratory symptoms like dry cough and shortness of breath have wide range of differential diagnosis. It is important to keep in mind esophageal cancer as possible reason for dry cough. Never forget about atypical disease presentations and rare cases.