An unusual cause of Dysphagia in a 76-year-old heavy smoker

Our plain-English summary of An unusual cause of Dysphagia in a 76-year-old heavy smoker, by A. Derweduwen, P. Nafteux, E. Verbeken, et al (Journal of Thoracic Oncology, 2013).

The study

• Authors: A. Derweduwen, P. Nafteux, E. Verbeken, J. Coolen, J. Vansteenkiste
• Journal: Journal of Thoracic Oncology
• Published: 2013;8(10):1339-40
• Type of article: Case report
• Read it: PubMed · Publisher

In plain English

This was a case report, published as an "Image of the Month", about a 76-year-old man in Belgium. He had trouble swallowing solid food and had lost 15% of his weight over 6 weeks. He was a former heavy smoker (35 pack-years) and had worked all his life as an orchestra conductor. A CT scan showed a large mass in the back of the chest around the lower esophagus, nearly closing it over about 10 cm. A camera exam found a narrowing over about 15 cm with no cancer on the inner lining. Needle samples showed large cancer cells that could not be identified further. Surgeons then looked inside the right chest and found widespread tumor deposits on the pleura. Biopsy staining led to a diagnosis of epitheloid mesothelioma. A detailed work history showed that he had most probably had significant asbestos exposure. He had worked for several years in auditoria in a building with an asbestos hazard that was made asbestos-free only in recent years. The authors wrote that the first findings led to the wrong idea of a different esophageal tumor. To their knowledge, only a few similar cases had been reported.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (single patient), published as an "Image of the Month"
• Who was studied: One 76-year-old man, a former heavy smoker (35 pack-years) and lifelong orchestra conductor, referred to University Hospital KU Leuven, Belgium, with dysphagia for solid food and 15% weight loss over 6 weeks
• Exposure: Probable significant asbestos exposure from working for several years in auditoria in a building with an asbestos hazard, made asbestos-free only in recent years. No fiber type or dose is given. Former heavy smoking (35 pack-years) is also reported.
• Main results:
  • CT of the chest showed a large mass in the posterior mediastinum around the distal esophagus, with near-complete compression over about 10 cm
  • Endoscopy showed a stenosis (narrowing) over about 15 cm without malignant lesions of the lining
  • Fine-needle aspiration found large malignant cells that could not be further specified
  • Right-sided thoracoscopy showed diffuse superficial tumor deposits on the visceral, parietal and diaphragmatic pleura
  • Biopsy staining was negative for thyroid transcription factor 1 and positive for calretinin and Wilms' tumor protein, establishing epitheloid mesothelioma
  • A detailed work history indicated the patient most probably had significant asbestos exposure
• The authors' conclusion: The authors stated that the initial presentation led to the wrong hypothesis of a submucosal esophageal tumor. They noted that, to their knowledge, only a few similar cases with mesothelial tumor surrounding the esophagus in the lower posterior mediastinum had been reported.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Dysphagia.

Related studies

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• Dysphagia due to mesothelioma infiltrating the oesophagus: palliative treatment — C.A. Lockwood, H.W. Jones, et al. (1989)
• Spirometry, rapid FEV1 decline, and lung cancer among asbestos exposed heavy smokers — J.W. Chien, D.H. Au, et al. (2007)
• Polymorphisms in oxidative stress-related genes are not associated with prostate cancer risk in heavy smokers — J.Y. Choi, M.L. Neuhouser, et al. (2007)
• Dietary inflammatory index and risk of lung cancer and other respiratory conditions among heavy smokers in the COSMOS screening study — P. Maisonneuve, N. Shivappa, et al. (2016)
• Mailing strategies and costs of recruiting heavy smokers in CARET, a large chemoprevention trial — B. Valanis, J. Blank, et al. (1998)

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