Keratinizing squamous cell carcinoma of the distal Esophagus in a young adult woman with celiac disease: a case report.

Esophageal squamous cell carcinoma (ESCC) usually affects the upper or middle esophagus and is strongly associated with tobacco and alcohol use. We report a 28-year-old woman with longstanding celiac disease who presented with progressive dysphagia, weight loss, retrosternal pain, and melena. Endoscopy showed a partially obstructing distal esophageal mass; biopsy confirmed moderately differentiated keratinizing ESCC, while duodenal biopsy showed active celiac disease. CT and PET imaging revealed regional lymphadenopathy without distant metastasis. She underwent feeding jejunostomy, nutritional support, and neoadjuvant chemoradiotherapy, but follow-up imaging showed interval disease progression. The patient's young age, squamous cell histology in a distal esophagus, and the absence of conventional risk factors make this an unusual presentation. This case emphasizes the need for high clinical suspicion and early endoscopic evaluation in young patients with celiac disease presenting with alarming symptoms, even in the absence of classic risk factors for esophageal cancer.