Esophageal Metastatic Adenocarcinoma Diagnosed with Endoscopic Ultrasound

Teh, Guo Xiang Jonathan; Tan, Damien Meng Yew; Khor, Jen Lock; Wan, Wei Keat; Wang, Yu Tien

doi:10.1159/000484133

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…EUS was only performed in nine of our patients but as shown in patient 3, is valuable in identifying submucosal EGJ tumors not visible on EGD and not obvious on CT scans. The utility of EUS in such situations has been shown in several case reports …”

Section: Discussionmentioning

confidence: 98%

Evaluation of symptomatic esophagogastric junction outflow obstruction

Ong

Namasivayam

Wang

2018

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 98%

Evaluation of symptomatic esophagogastric junction outflow obstruction

Ong

Namasivayam

Wang

2018

J of Gastro and Hepatol

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“…Metastatic esophageal tumor is relatively rare, and most metastatic esophageal tumors take the form of submucosal solid tumors. 1 – 4 To the best of our knowledge, this is the first case of submucosal metastasis of invasive mucinous adenocarcinoma retaining mucin producibility.…”

Section: Case Reportmentioning

confidence: 87%

A Rare Case of Esophageal Metastasis of Invasive Mucinous Adenocarcinoma of the Lung

2022

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A 66-year-old woman was referred to our hospital because of an incidental finding of a 50 mm mass in the lower lobe of the left lung with liver and lymph node metastases. Lymph node biopsy revealed mucinous adenocarcinoma. Chemotherapy was initiated, which markedly reduced the tumor size. Two months after starting chemotherapy, she developed dysphagia. A plain computed tomography scan revealed circumferential and concentric wall thickening of the lower esophagus adjacent to the lung tumor (Figure 1). Endoscopy showed stenosis in the lower esophagus with apparently normal overlying mucosa (Figure 1). Endoscopic ultrasound revealed a submucosal cystic lesion measuring 30 mm in diameter with an irregular septum (Figure 1). Fine-needle aspiration was performed for diagnosis, which also helped to reduce the volume of cystic fluid, thereby improving the esophageal stricture. Histology revealed adenocarcinoma with intracytoplasmic mucin (Figure 2). Immunohistochemistry staining showed abundant CK7 and HNF4a, consistent with invasive mucinous adenocarcinoma, suggesting esophageal metastasis from the lung tumor (Figure 2). Metastatic esophageal tumor is relatively rare, and most metastatic esophageal tumors take the form of submucosal solid tumors. [1][2][3][4] To the best of our knowledge, this is the first case of submucosal metastasis of invasive mucinous adenocarcinoma retaining mucin producibility. DISCLOSURESAuthor contributions: S. Kimura and M. Kobayashi drafted the article equally. I. Onishi provided the pathological diagnosis and assisted in preparation of the manuscript. M. Kobayashi supervised the article. The final version of the manuscript was approved by all authors. M. Kobayashi is the article guarantor. Figure 1. Computed tomography and endoscopic ultrasound images. (A) Computed tomography revealed circumferential and concentric wall thickening in the lower esophagus adjacent to the lung tumor. (B) The endoscopic view of the lower esophagus showing stenosis with apparently normal overlying mucosa. (C) Endoscopic ultrasound showed a submucosal cystic lesion measuring 30 mm in diameter with an irregular septum.

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“…Differential diagnoses of metastatic esophageal cancer include esophageal submucosal tumors and rare types of primary esophageal cancer (e.g., basaloid squamous cell carcinoma, sarcoma, lymphoma). Ultrasonography has been reported to be useful for making a diagnosis of metastatic esophageal cancer [ 4 ]. The cancer is commonly treated with standard chemotherapy for the primary site.…”

Section: Discussionmentioning

confidence: 99%

A rare case of esophageal metastasis from signet-ring cell carcinoma of the cecum

Tanaka,

Chino,

Kajiwara

et al. 2023

surg case rep

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Background Metastatic esophageal cancer is rare. Its common primary lesions include lung cancer and breast cancer. Metastatic esophageal cancer originating from colorectal cancer is rarer. Case presentation A 79-year-old woman visited our hospital because of lower abdominal discomfort. She was endoscopically diagnosed with type 0–IIa + IIc cancer of the cecum, and biopsy of the lesion showed signet-ring cell carcinoma. With a preoperative clinical staging of cStage I (cT2, cN0, cM0), the patient underwent laparoscopic ileocecal resection with D3 lymphadenectomy. Histopathological examination of the resected specimens revealed signet-ring cell carcinoma [type 4, pT4a, pN3 (No. 203), M0, pRM1, stage IIIc, R1]. Despite radial margin positivity, the patient refused resection of the residual tumor and received oral tegafur and uracil. KRAS mutation test showed KRAS wild-type colon cancer, but she refused anti-epidermal growth factor receptor therapy. One year after surgery, her blood carcinoembryonic antigen concentration elevated. Colonoscopy showed anastomotic recurrence and biopsy of the lesion showed signet-ring cell carcinoma. Upper gastrointestinal endoscopy showed multiple longitudinal submucosal tumors with erosions on their surfaces in the esophagus. Tumor biopsy revealed signet-ring cell carcinoma. Immunohistochemistry showed that the histological type of the esophageal tumors was the same as that of the primary colon cancer. Based on these findings, the esophageal tumors were diagnosed with metastasis from signet-ring cell carcinoma of the cecum. The oral chemotherapy was replaced with FOLFOX plus bevacizumab. However, the patient’s condition required treatment discontinuation, and she died of cancer progression 1 year and 5 months after surgery. Conclusions To our knowledge, this is the first case report on metastatic esophageal cancer from signet-ring cell carcinoma of the cecum. Esophagoscopy showed multiple longitudinal submucosal tumors, which is similar to an endoscopic finding of intramural metastasis from primary esophageal cancer. We consider that the multiple longitudinal submucosal tumors are a notable feature of our case. When metastatic esophageal cancer is suspected, clinicians, endoscopists, and pathologists should consider signet-ring cell carcinoma of the colon as one of potential primary lesions. This consideration could lead the specialists to appropriate examinations and treatments, thereby improving clinical outcomes in patients with the metastasis.

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Esophageal Metastatic Adenocarcinoma Diagnosed with Endoscopic Ultrasound

Cited by 6 publications

References 7 publications

Evaluation of symptomatic esophagogastric junction outflow obstruction

Evaluation of symptomatic esophagogastric junction outflow obstruction

A Rare Case of Esophageal Metastasis of Invasive Mucinous Adenocarcinoma of the Lung

A rare case of esophageal metastasis from signet-ring cell carcinoma of the cecum

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