年轻成人女性乳糜泻患者远端食管角化型鳞状细胞癌：一例病例报告

文献信息

中文摘要

食管鳞状细胞癌（ESCC）通常累及食管上段或中段，并与吸烟和饮酒密切相关。我们报告一例28岁女性，患有长期乳糜泻，表现为进行性吞咽困难、体重减轻、胸骨后疼痛和黑便。内镜检查显示远端食管部分梗阻性肿块；活检证实为中分化角化型ESCC，而十二指肠活检显示活动性乳糜泻。CT和PET成像显示区域淋巴结肿大，无远处转移。她接受了喂养性空肠造口术、营养支持和新辅助放化疗，但随访影像显示疾病进展。该患者年轻、远端食管鳞状细胞组织学以及缺乏传统危险因素，使其成为不寻常的表现。本病例强调，对于出现警示症状的年轻乳糜泻患者，即使没有食管癌的典型危险因素，也需要高度临床怀疑和早期内镜评估。

英文摘要

Esophageal squamous cell carcinoma (ESCC) usually affects the upper or middle esophagus and is strongly associated with tobacco and alcohol use. We report a 28-year-old woman with longstanding celiac disease who presented with progressive dysphagia, weight loss, retrosternal pain, and melena. Endoscopy showed a partially obstructing distal esophageal mass; biopsy confirmed moderately differentiated keratinizing ESCC, while duodenal biopsy showed active celiac disease. CT and PET imaging revealed regional lymphadenopathy without distant metastasis. She underwent feeding jejunostomy, nutritional support, and neoadjuvant chemoradiotherapy, but follow-up imaging showed interval disease progression. The patient's young age, squamous cell histology in a distal esophagus, and the absence of conventional risk factors make this an unusual presentation. This case emphasizes the need for high clinical suspicion and early endoscopic evaluation in young patients with celiac disease presenting with alarming symptoms, even in the absence of classic risk factors for esophageal cancer.