S4380 Dysphagia as a Sentinel Symptom of Mediastinal Small Cell Lung Carcinoma

Introduction: Dysphagia is an uncommon presenting symptom of lung cancer, reported in only 1–2% of cases, and often leads clinicians to pursue gastrointestinal etiologies initially. Small cell lung carcinoma (SCLC) may rarely manifest with esophageal symptoms due to extrinsic compression or invasion. We present a case of SCLC in a young adult with progressive dysphagia as the initial presentation. Case Description/Methods: A 29-year-old man with no history of tobacco use presented with a two-month history of progressive dysphagia to solids and liquids, accompanied by nausea, vomiting, and 50-pound weight loss. Computed tomography of the thorax in the emergency department showed a large mediastinal mass invading the esophagus with additional lymphadenopathy and hepatic lesions suggestive of metastasis. Esophagogastroduodenoscopy revealed a submucosal esophageal mass with mucosal erosion. Endoscopic ultrasound demonstrated a 64 × 43 mm hypoechoic mediastinal mass compressing the esophagus. Fine needle biopsy confirmed small cell carcinoma on cytology with positive synaptophysin, chromogranin, and CD56 immunostaining and high Ki-67 index (60%). The patient underwent percutaneous endoscopic gastrostomy tube placement for nutritional support and was initiated on cisplatin and etoposide chemotherapy. Discussion: This case underscores the importance of considering thoracic malignancies in patients presenting with unexplained dysphagia, particularly when endoscopy suggests extrinsic esophageal compression. Endoscopic ultrasound-guided tissue acquisition is an invaluable diagnostic tool when mucosal biopsies are inconclusive. Early recognition and tissue diagnosis are critical in initiating timely treatment in aggressive malignancies such as SCLC, which may present atypically even in young, non-smoking individuals.