A CASE OF UNDIFFERENTIATED CARCINOMA OF THE ESOPHAGUS WITH ECTOPIC ACTH SYNDROME

Abstract

A 65-year-old woman was seen at the hospital because of discomfort of the chest lasting from late October 1999. Endoscopical examination showed 2-type shaped, poorly differentiated squamous cell carcinoma of the middle intrathoracic esophagus. She underwent a surgical resection of the esophagus by right thoracotomy and laparotomy on January 13, 2000 (Mt, 2-type, 2.5×2.0×1.0 cm). This tumor was present within the submucosal layer of the esophagus (pT1b), and its pathological finding was small cell type undifferentiated carcinoma. Histopathological stage of esophageal cancer was pStage 1.
From April 1, 2000, she felt a decrease of urination, edema and general fatigue, and was admitted again on April 11. The blood potassium level was low (2.1mEq/l), and blood ACTH and cortizol levels were high (1, 203.9pg/ml and 112.5 μg/dl, respectively). Abdominal CT scan showed multiple liver metastasis and bilateral hypertrophy of the adrenal glands. And immunohistochemical stain to detect ACTH on her esophageal cancer was positive. Ectopic ACTH syndrome induced by liver metastasis of esophageal cancer was diagnosed. She was treated with a blocker of adreno-cortizol synthesis, op'-DDD, and combined chemotherapy with CDDP and CPT-11, but she died on May 31, 2000.