Synchronous cervical esophageal squamous cell carcinoma esophagus and GEJ adenocarcinoma in a post allogeneic transplant in acute lymphoblastic leukemia patient: Complex management issue of a very rare presentation

Abstract

Author(s): Ahmad Al Ghoche*, Abdullah Al Rawahi, Rami Abu Omar, Asma Naz Nadaf, Anjali Jain, Sercan Yilamz and Mansour Al-Moundhri

The histological subtypes of Esophageal Adenocarcinoma (EAC) and Esophageal Squamous Cell Carcinoma (ESCC) continue to be fatal diseases throughout the world. Lymphoblastic Leukemia (ALL) is a heterogeneous hematologic disease characterized by the proliferation of immature lymphoid cells in the bone marrow, peripheral blood, and other organs. Bone marrow transplantation offers a curative therapy in some patients with malignant and nonmalignant diseases. However, one important late complication in transplant survivors is the development of secondary malignancies including solid tumors; among these, only few cases of EC have thus been reported. Hereby we describe a case of a 32 year old male patient who developed synchronous adeno- and squamous esophageal carcinomas of gastroesophageal junction and cervical esophagus respectively, in a known case of transplanted relapsed acute lymphoblastic leukemia in childhood. The presentation represented a management challenge in terms of employing and sequencing of treatment modalities in treatment of both esophageal carcinomas. Patient was treated with neoadjuvant FLOT4 followed by surgery then concurrent chemoradiotherapy and ended with 4 cycles of adjuvant FLOT4. To our knowledge, this is the first reported case with 2 synchronous esophageal carcinomas having two different pathologies in a cured case of relapsed ALL. As in the case presented here, prior chemotherapy, severe graft versus host disease, and other confounding variables leading to the development of secondary disease may alter the usual activity of BMDC as a possible tumor development mechanism.

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