P2916 - Dysphagia as a Sentinel Symptom of Mediastinal Small Cell Lung Carcinoma

Mutaz Kalas, MD¹, Shivangini Duggal, MD², Mostafa Eysha, MD¹, Alan Jurado, MD³, Jesus Guzman, MD⁴, Sherif E. Elhanafi, MD⁵
1Texas Tech University Health Science Center El Paso, El Paso, TX; 2Department of Internal Medicine at Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso TX, USA, El Paso, TX; 3Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX; 4Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX., El Paso, TX; 5Texas Tech University Health Sciences Center, El Paso, TX

Introduction: Dysphagia is an uncommon presenting symptom of lung cancer, reported in only 1–2% of cases, and often leads clinicians to pursue gastrointestinal etiologies initially. Small cell lung carcinoma (SCLC) may rarely manifest with esophageal symptoms due to extrinsic compression or invasion. We present a case of SCLC in a young adult with progressive dysphagia as the initial presentation.

Case Description/

Methods: A 29-year-old male with no history of tobacco use presented with a two-month history of progressive dysphagia to solids and liquids, accompanied by nausea, vomiting, and 50-pound weight loss. Computed tomography of the thorax in the emergency department showed a large mediastinal mass invading the esophagus with additional lymphadenopathy and hepatic lesions suggestive of metastasis. Esophagogastroduodenoscopy (EGD) revealed a submucosal esophageal mass with mucosal erosion. Endoscopic ultrasound (EUS) demonstrated a 64 x 43 mm hypoechoic mediastinal mass compressing the esophagus. Fine needle biopsy confirmed small cell carcinoma on cytology with positive synaptophysin, chromogranin, and CD56 immunostaining and high Ki-67 index (60%). The patient underwent PEG tube placement for nutritional support and was initiated on cisplatin and etoposide chemotherapy.

Discussion: This case underscores the importance of considering thoracic malignancies in patients presenting with unexplained dysphagia, particularly when endoscopy suggests extrinsic esophageal compression. EUS-guided tissue acquisition is an invaluable diagnostic tool when mucosal biopsies are inconclusive. Early recognition and tissue diagnosis are critical in initiating timely treatment in aggressive malignancies such as SCLC, which may present atypically even in young, non-smoking individuals.


Figure: A) CT Thorax: Large mediastinal mass, compressing the esophagus. B) EGD: Partially obstructing, friable, eroding malignancy in the lower esophagus starts from 32 to 36 cm. C) Upper EUS: Mass measuring 64 x 43 mm in the mediastinum, compressing and invading the lower esophagus.

Disclosures:
Mutaz Kalas indicated no relevant financial relationships.
Shivangini Duggal indicated no relevant financial relationships.
Mostafa Eysha indicated no relevant financial relationships.
Alan Jurado indicated no relevant financial relationships.
Jesus Guzman indicated no relevant financial relationships.
Sherif Elhanafi indicated no relevant financial relationships.

Mutaz Kalas, MD¹, Shivangini Duggal, MD², Mostafa Eysha, MD¹, Alan Jurado, MD³, Jesus Guzman, MD⁴, Sherif E. Elhanafi, MD⁵. P2916 - Dysphagia as a Sentinel Symptom of Mediastinal Small Cell Lung Carcinoma, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.