Dados do Trabalho

Título

Neoplasia de Esôfago na Infância: Relato de Caso

Apresentação do caso

JCPS, 9 years old, female, black, born in Rio de Janeiro. Onset of dysphagia and weight loss, evolving with right cervical adenomegaly. Computed tomography in an Emergency Hospital showed esophageal thickening and after an unsuccessful attempt to pass the nasogastric tube, parenteral nutrition was iniciated.Transferred to a reference Oncological Hospital where endoscopy was performed, which showed circumferential infiltration of the cervical esophagus preventing the progression of the device. Biopsy of cervical lymph nodes with histopathological report of metastatic Epidermoid Carcinoma. A gastrostomy was required. New CT scans confirmed concentric cervical esophageal thickening extending to the superior mediastinum, with obliteration of its lumen. Treatment with radio and chemotherapy was started, with Cisplatin. Radiotherapy was conventional on the tumor and regional drainages, at a dose of 45Gy. Progression of bilateral cervical disease during the third week of radiation. Palliative treatment continued, due to improvement in dysphagia. Five months after radiotherapy, patient was hospitalized for abscess on the large right cervical mass and pneumonia, already in a state of cachexia. New endoscopy through gastrostomy with stenosis in cervical esophagus. Surgery contraindicated. It progressed to death ten months after diagnosis.

Discussão

Esophageal neoplasia is rare in children and adolescents and its description is limited to a few case reports. Epithelial esophageal tumors usually arise as a result of chronic irritation from environmental carcinogens and reflux of gastric contents after a long latency period. In the case described there was no previous exposure. It occurs more often in male adolescents, in the distal esophagus, and the most frequent histological type is Adenocarcinoma, which has a worse prognosis than epithelial tumors. Tumors in the cervical esophagus are rare, occurring in less than 5% of cases, as well as Epidermoid Carcinoma, both present in the case reported. Possibly because of the advanced clinical condition and the aggressiveness of the disease in this age group, there was no response to treatment, with an early outcome of death.

Comentários finais

Due to the rarity of this tumor, there are no established guidelines for its treatment. Despite the use of multidrug therapy, radiotherapy and radical surgery, the prognosis remains poor. The role of radiotherapy is not well established, and it can be used radically or palliatively.

Palavras-chave

cancer, children, esophagus

Área

Radioterapia