A 68-year-old woman, with a personal history of interest, reported smoking 20 cigarettes/day for the last 40 years, and as surgical interventions: cholecystectomy, tonsillectomy and bilateral adnexectomy (due to uterine polymyomatosis). Two years earlier, she was seen at a gastrointestinal clinic for moderate to solid dysphagia, with no other accompanying symptoms. An upper endoscopy was performed and a hiatal hernia was found, and treatment with proton pump inhibitors was recommended, with considerable improvement in symptoms. Subsequently, during the consultation period, the patient presented with severe epigastric pain of several months' duration, and a second endoscopy was repeated, revealing a lesion in the middle third of the oesophagus, biopsied and reported as an ulcerated and infiltrating small cell carcinoma of the oat-cell type. In view of these findings, the patient underwent further studies and different explorations with the fundamental objective of finding the primary tumour (thinking of a pulmonary origin given the histological species of the neoplasm) and staging the disease.
On examination, the patient was in good general condition, afebrile, with no findings of adenopathies or relevant data on cardiopulmonary auscultation, with a normal abdomen except for the right subcostal and infraumbilical scar and no neurological alterations.
Laboratory tests showed no relevant alterations. The barium oesophagogastroduodenal study showed a flat, ulcerated lesion 5 cm from the oesophagogastric junction, about 5 cm long, which discreetly reduced the lumen of the esophagogastric junction, the rest of the study being normal.

The thoraco-abdominal CT scan showed a neoplasm in the middle third of the oesophagus, causing a reduction in its lumen, with lymphadenopathy in the subcarinal area, left supraclavicular (1.5 cm); in the abdomen, lymphadenopathy in the retroperitoneum, retrocrural area and right iliac chain; images suggestive of bilobular liver metastases and a large splenic cyst. There was no evidence of a space-occupying lesion in the lung. Fibrobronchoscopy revealed no pathological findings. A transthoracic puncture aspirate was positive for oat-cell carcinoma, which could indicate pleural invasion.

Echoendoscopy showed a vegetating and ulcerated oesophageal tumour, extending from 30 to 35 cm and infiltrating 2/3 of its sides, but allowing passage of the endoscope. Between 28 and 32 cm there was a well-demarcated retrocardiac extrinsic mass which did not infiltrate the oesophagus. Multiple celiac adenopathies were found. And biopsy of the lesion is reported as small cell oat-cell carcinoma. Cranial CT did not demonstrate any pathological findings.
Given the extent of the neoplasm, surgery was ruled out and chemotherapy was considered as the main therapeutic option. At the end of this study, the patient was being treated in the Oncology Unit of our hospital (CDDP plus etoposide).