Esophageal Cancer Associated with a Right Aortic Arch
Karam Yatribi*, Abdelmalik Mouzount, Tayeb Kebdani and Noureddine Benjaafar
Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
- *Corresponding Author:
- Karam Yatribi
Department of Radiotherapy
National Institute of Oncology
Mohammed V University, Rabat- Morocco
Tel: +212 664072582
Received date: June 22, 2017; Accepted date: August 12, 2017; Published date: August 18, 31, 2017
Citation: Yatribi K, Mouzount A, Kebdani T, Benjaafar N (2017) Esophageal Cancer Associated with a Right Aortic Arch. Arch Can Res. Vol.5 No.3:147. doi:10.21767/2254-6081.1000147
A 52-year-old woman presented at our department for
progressive dysphagia for almost 1 year, with food vomiting.
An esophagoscopy showed a polypoidal mass, 25 cm from the
incisors, in the middle third of the esophagus. Biopsy
confirmed the presence of a squamous cell carcinoma shown
in Figure 1.
Figure 1: Panel A: A CT scan (axial plane) of the chest showing a right aortic arch (red arrow) and an esophageal
cancer (white arrow).
Computed tomography showed an ulcerative tumor in the
esophageal wall, measuring 50 mm × 23 mm × 73 mm, 8 cm
from the cardia with intimate contact with the trachea, the
keel and the left pulmonary artery (Panel A) shown in Figure 2.
Figure 2: Panel B: Computed tomography (coronal plane) revealing a right aortic arch (white arrow).
CT revealed also a right aortic arch, classified as an aortic
anomaly of type III-A: A mirror image branching of the normal
left aortic arch, according to Edward’s classification (Panel B).
Type IIIB is the most frequent, followed by Type IIIA. The
classification of aortic anomalies by Edward’s et al. is based on
their theoretical concept of the development of the aortic
arch. Right aortic arch is a rare condition, this congenital
vascular anomaly is thought to occur in approximately ~0.1%
(Range 0.05% to 0.2%) of the population, and it is reported to
represent from 1% to 2% of congenital diseases of the heart
and aorta. In patients with a right aortic arch, the aorta
surrounds the esophagus and trachea, causing the
compression and deviation of these structures, as well as
deviation of the recurrent laryngeal nerve. This is why great care must be taken when the surgical option is decided. The
main symptom of right aortic arch is dysphagia, due to
compression of the esophagus by the vascular ring created by
the arch. In our case, dysphagia was not noted prior to the
development of the cancer. Esophageal cancer associated with
right aortic arch is very rare, only few cases have been cited in
the literature; the squamous carcinoma cell is the most
common type. The surgical resection in this rare combination
is very rare, but some cases have been reported in the
literature. A right thoracotomy is the most common approach for the resection of the esophageal cancer, but in the presence
of a right aortic arch, we prefer a left thoracotomy. The mean
age was 62 years.
After multidisciplinary board meeting, she benefited from a
jejunotomy tube. An exclusive chemoradiation was provided,
but given the alteration of the general state, important weight
loss (10 Kg in 3 months, her actual weight is 35 kg), and tumor
progression, a palliative radiation was decided (30 Gy, 3Gy per
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