Downhill Esophageal Variceal Rupture Caused by Superior Vena Cava Syndrome in NUT Carcinoma: A Case Report.

NUT carcinoma is a rare and aggressive malignancy that frequently arises in midline structures and is often associated with superior vena cava (SVC) syndrome. However, life-threatening complications related to venous congestion are not well characterized. Herein, we report a case of a 14-year-old boy with mediastinal NUT carcinoma who developed downhill esophageal varices with massive bleeding secondary to SVC obstruction. Despite multimodal therapy including radiation and chemotherapy, the disease progressed rapidly. Three months after admission, the patient presented with hematemesis, and endoscopy revealed bleeding esophageal varices, which were successfully treated with endoscopic ligation. This case highlights a rare but potentially fatal complication of SVC syndrome in NUT carcinoma. Clinicians should be aware of the risk of esophageal variceal formation and bleeding in patients with severe SVC obstruction.