Background: The incidence of malignant ESOPHAGEAL-respiratory fistulas in ESOPHAGEAL CANCER patients is not so frequent. The fistula development in ESOPHAGEAL CANCER may be due to advanced disease or a radiotherapy-related complication. Rarely, a pulmonary abscess may develop, which is the most dreadful complication resulting in dismal outcomes. Here, we reported 2-cases of ESOPHAGEAL-respiratory fistula,one with ESOPHAGEAL bronchial fistula and the other with ESOPHAGEAL pleural fistula. Case reports: A 46-year-aged man presented with complaints of difficulty in swallowing for 4 months. CECT chest showed an ESOPHAGEAL growth of 8. 5 cm in the lower esophagus. The patient received palliative radiotherapy followed by palliative chemotherapy and showed some improvement in dysphagia. Nine months after the start of treatment, the patient’, s dysphagia began to worsen, and he was put on oral metronomic chemotherapy. After 1-year of metronomic chemotherapy, the patient developed cough and chest pain and was diagnosed with an ESOPHAGEAL-pleural fistula with chest wall collection and pleural effusion. The patient was managed conservatively and later lost to follow-up. Another 65-year-old patient presented with dysphagia for 3-months. CECT chest showed an ESOPHAGEAL growth of 5. 5 cm in the middle esophagus. The patient received palliative radiotherapy, after which the dysphagia improved. In 3rd month of follow up patient’, s dysphagia worsened,barium swallow showed ESOPHAGEAL-bronchial fistula. The patient was managed symptomatically and later lost to follow-up. Conclusions: Fistula formation and subsequent abscess results in a poor prognosis. With advancing disease and compromised general condition of the patient, palliation of symptoms is a significant challenge. Treatment becomes difficult due to the rare occurrence of fistulas and the non-standardization of the treatment protocol. Invasive treatment includes ESOPHAGEAL-pulmonary resection, endoscopic placement of self-expandable covered stents, drainage of empyema and obliteration of empyema cavity, ESOPHAGEAL diversion, and non-invasive treatment includes best supportive care. However, even with appropriate treatment, the outcome is dismal.

Background: ESOPHAGEAL CANCER is the 7th most common CANCER in Iran. The northern part of the country shows the highest incidence for this malignancy. In this study we present some epidemiological and clinicopathological characteristics of patients with ESOPHAGEAL carcinoma in this region.Methods: In a cross sectional study, 238 ESOPHAGEAL CANCER patients were enrolled in a prospective study of neoadjuvant chemo-radiation treatment in a 4-year period (2006-2009). In an oncology clinic their epidemiologic characteristics and clinicopathological findings were registered in a preplanned file. Data consisted of age, sex, race, occupation, residential location, smoking, addiction history, signs and symptoms, blood biochemistry profile, imaging and endoscopic findings. The data were analyzed with the SPSS software. Results: The mean age of the patients was (55% female) 59 years. They were mostly Fars (63%) and Turkmen (13%). Seventy two percent were residents of rural area, 20% were smokers and 22.3% were opium addict and its analogues. Only 1.3% of patients consumed alcohol. The most common presenting symptom was dysphagia (93.7%), mainly grade III dysphagia (53%). Location of tumor in esophagus was in the middle third in 53.4% and lower segment in 44.5%. 65 % of the patients had an abnormal esophagogram. On endoscopic evaluation the most common types of tumors were polypoid, vegetative and fungoid, respectively. Mean tumor length was 5.7 cm. The most common histology type was squamus cell carcinoma (99.1%) which was moderately differentiated in 51.3% of these patients. No significant relationship was found between the grade of dysphagia with the macroscopic type and the pathologic grade of the tumor in this study. Conclusion: Squamous cell carcinoma comprised more than 99% of all ESOPHAGEAL CANCERs in our patients and this histological type is the prominent type in the Northeast of Iran. Middle ESOPHAGEAL segment is the major site for this type of CANCER which unfortunately most patients present with grade III. Dysphasia reflects the advanced stage of the disease.

Metastasis of CANCERs to finger is a very rare finding. Herein, we report on an 80-year-old woman presented with a large painless ulceroproliferative lesion of her right thumb. The lesion was surgically excised. Pathological report revealed a papillary adenocarcinoma-a distant metastasis from the esophagus. The patient had an uneventful course and was discharged from the hospital