Differential Diagnosis for Esophageal Lesion
- Single most likely diagnosis
- Squamous cell carcinoma of the esophagus: The patient's history of accidental lye ingestion, which is a known risk factor for squamous cell carcinoma, combined with the presentation of dysphagia, postprandial nausea, and nonbilious, nonbloody vomiting, points towards this diagnosis. The location of the lesion in the distal esophagus and the description of the mucosa as friable and ulcerated on upper endoscopy also support this diagnosis.
- Other Likely diagnoses
- Adenocarcinoma of the esophagus: Although less likely given the patient's history, adenocarcinoma is a common type of esophageal cancer, especially in the distal esophagus. The patient's symptoms and the findings on computed tomography and upper endoscopy could also be consistent with adenocarcinoma.
- Gastric adenocarcinoma: Given the location of the lesion near the gastroesophageal junction, gastric adenocarcinoma could be considered, especially if the lesion extends into the stomach or if there are other risk factors for gastric cancer.
- Do Not Miss diagnoses
- Esophageal stricture due to lye ingestion: While the patient's symptoms and findings suggest a malignant process, it's crucial not to miss the possibility of a benign stricture caused by the previous lye ingestion, which could mimic or coexist with a malignant lesion.
- Infectious esophagitis: Although less likely given the chronic nature of the symptoms and the presence of a mass lesion, infectious esophagitis (e.g., due to Candida or herpes simplex virus) could present with similar symptoms, especially in an immunocompromised or elderly patient.
- Rare diagnoses
- Gastric carcinoid: This is a less common type of tumor that could present with similar symptoms if located near the gastroesophageal junction. However, it is much rarer than the other options and would be considered only if other diagnoses are ruled out.
- Other rare esophageal tumors: Including leiomyosarcoma, lymphoma, or metastatic disease to the esophagus from another primary site. These would be considered rare and would require specific risk factors or findings not mentioned in the case presentation.