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Our patient was a 68 Age - year Age - old Age woman Sex with chronic History obstructive History pulmonary History disease History .
She had no History history History of History gastroesophageal History reflux History disease History or History esophageal History disorders History but was found to have a progressive Detailed_description solitary Detailed_description pulmonary Biological_structure nodule Sign_symptom ( 1×1.3cm Area ).
A right Detailed_description lower Detailed_description wedge Detailed_description resection Therapeutic_procedure was performed in December Date 2011 Date and the University Nonbiological_location of Nonbiological_location Iowa Nonbiological_location pathology Nonbiological_location department Nonbiological_location identified the tumor Coreference as a LCNEC Disease_disorder .
Approximately six Date months Date after Date her operation, our patient started having slowly Detailed_description progressing Detailed_description dysphagia Sign_symptom for Detailed_description both Detailed_description solids Detailed_description and Detailed_description liquids Detailed_description .
A positron Diagnostic_procedure emission Diagnostic_procedure tomography Diagnostic_procedure ( PET Diagnostic_procedure ) scan performed in 2012 Date , one Date year Date post Date surgery Date , was unremarkable Lab_value for recurrence or metastasis.
Repeat computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) in June Date 2013 Date ( 18 Date months Date post Date surgery Date ) did not show any recurrence Sign_symptom (Figure 1).
Our patient had an esophagogastroduodenoscopy Diagnostic_procedure ( EGD Diagnostic_procedure ) and barium Diagnostic_procedure swallow Diagnostic_procedure that revealed no stricture Sign_symptom of her esophagus Biological_structure but failure Sign_symptom of primary Biological_structure and Biological_structure secondary Biological_structure peristaltic Biological_structure waves Biological_structure and reflux Biological_structure .
In July Date 2013 Date , esophageal Diagnostic_procedure manometry Diagnostic_procedure found failure Sign_symptom of the lower Detailed_description esophageal Detailed_description sphincter Detailed_description to Detailed_description relax Detailed_description , with a residual Diagnostic_procedure pressure Diagnostic_procedure of 32mmHg Lab_value .
Our patient was treated with calcium Medication channel Medication blockers Medication with partial relief Sign_symptom .
Thus far, up Duration to Duration 18 Duration months Duration post Duration resection, our patient had been able to maintain Lab_value her weight Diagnostic_procedure and her basic Diagnostic_procedure laboratory Diagnostic_procedure parameters Diagnostic_procedure , including hemoglobin Diagnostic_procedure , albumin Diagnostic_procedure and cholesterol Diagnostic_procedure levels.
However, in January Date 2014 Date , she reported worsening dysphagia Sign_symptom and weight Sign_symptom loss Sign_symptom of 10lbs Lab_value over Duration a Duration period Duration of Duration one Duration month Duration .
She was referred Clinical_event to our center Nonbiological_location for further treatment Therapeutic_procedure of her achalasia Disease_disorder .
A repeat esophageal Diagnostic_procedure manometry Diagnostic_procedure showed an elevated Lab_value lower Diagnostic_procedure esophageal Diagnostic_procedure sphincter Diagnostic_procedure pressure Diagnostic_procedure of 50mmHg Lab_value as well non Detailed_description - propagative Detailed_description , non Detailed_description - peristaltic Detailed_description contractions Sign_symptom throughout her esophageal Biological_structure musculature Biological_structure (Figure 2).
A repeat EGD Diagnostic_procedure with an intention to perform therapeutic pneumatic Therapeutic_procedure dilation Therapeutic_procedure showed a nearly Detailed_description circumferential Detailed_description ulcerated Detailed_description , fungating Detailed_description mass Sign_symptom from approximately Distance 36cm Distance that extended to her gastroesophageal Biological_structure junction Biological_structure at Distance 39cm Distance .
Biopsies Diagnostic_procedure revealed a LCNEC Disease_disorder with similar Detailed_description features Detailed_description to Detailed_description the Detailed_description primary Detailed_description tumor Detailed_description resected Detailed_description in Detailed_description 2011 Detailed_description , and was concluded to be a metastasis Sign_symptom .
Subsequently, a repeat CT Diagnostic_procedure scan Diagnostic_procedure revealed progressive Detailed_description diffuse Detailed_description metastatic Disease_disorder disease Disease_disorder .
Our patient underwent two Detailed_description courses Detailed_description of chemotherapy Medication but died Outcome from the disease after Date six Date months Date .