A 64-year-old man presents with symptoms of difficulty swallowing and weight loss of 10 lb. He has no prior history of heartburn, stomach ulcers, or difficulty swallowing. He smokes one pack a day for the past 45 years and drinks approximately 5 oz of alcohol a day. He is thin appearing, there are no oral lesions, and the
remaining examination is normal. Esophagoscopy reveals a midesophageal narrowing with ragged ulcerating, and biopsies are taken. Which of the following is the most likely diagnosis?
(A) adenocarcinoma of esophagus
(B) esophageal web
© achalasia
(D) squamous cell carcinoma of esophagus
(E) esophageal leiomyoma
solution:
(D) The history of weight loss and dysphagia suggests carcinoma of the esophagus, and squamous cell carcinoma is a disease that occurs in older men who drink and smoke heavily. Smoking and or excessive drinking are considered etiologic factors in the development of squamous cell carcinoma. Adenocarcinomas
arise within dysplastic columnar epithelium in the distal esophagus, usually in the presence of chronic gastric reflux