Primary Esophageal Adenocarcinoma With Distant Metastasis to the Skeletal Muscle

Abstract

Hematogenous metastasis of esophageal adenocarcinoma to the skeletal muscle is uncommon. We report a rare case of esophageal adenocarcinoma with metastasis to the skeletal muscle. During pretherapeutic examination, a painful mass was detected in the left thigh of a 49-yearold man. Endoscopic biopsy identified poorly differentiated, advanced esophageal adenocarcinoma. Computed tomography (CT) revealed wall thickening in the distal esophagus. Two enlarged lymph nodes were detected-the middle thoracic paraesophageal lymph node in the mediastinum and the right cardiac lymph node. 18F-fluorodeoxyglucose (FDG) positron emission tomography demonstrated left thigh metastasis, which had not been detected by CT 3 weeks previously, with increased accumulation of FDG. Therefore, ultrasound-guided coreneedle biopsy was performed. Histologic and immunohistochemical findings supported a diagnosis of poorly differentiated adenocarcinoma. The final diagnosis was primary esophageal adenocarcinoma with distant metastasis to the skeletal (left thigh) muscle. The rate of disease progression in this case emphasizes the malignant potential of esophageal adenocarcinoma. A few cases of skeletal metastasis from advanced esophageal adenocarcinoma have been previously reported. However, rapid metastasis to a distant skeletal muscle with no other hematogenous metastasis is quite rare. Early detection and rapid treatment are especially important in cases of esophageal adenocarcinoma.

A long-term survival case after surgical resection of skeletal muscle metastasis following esophagectomy for squamous cell carcinoma of the esophagus

“…FDG–PET is more accurate than CT, especially in body regions that are not routinely evaluated by CT [7]. In our case, FDG–PET was useful to detect muscle metastasis.…”

Skeletal muscle metastasis from oesophageal adenocarcinoma — case report and literature review

“…The reason for the rare occurrence of oesophageal cancer metastases in this location is not fully understood. Some authors suggest that it may be associated with rich blood supply, systolic activity, frequent pH changes, and the production of lactic acid in skeletal muscles, which inhibit the development of cancer cells in this area [4].…”

“…Diagnosis of skeletal muscle metastasis is difficult, and it is often misdiagnosed in physical examination and imaging examinations as sarcoma or other soft tissue pathologies [4]. Ultrasound is used to differentiate solid and cystic lesions [5], while PET is considered to be a more specific study than computed tomography in imaging lesions in skeletal muscles.…”

“…Regardless of the treatment used, patients with primary oesophageal cancer with distant metastases have a poor prognosis. The five-year survival rate is estimated at around 5% [4]. Diagnosis of metastases in skeletal muscle is usually associated with terminal stage of the disease and very poor prognosis [9].…”

Skeletal muscle metastasis from signet ring cell esophageal adenocarcinoma

“…Twenty-one cases, including the present report, have described esophageal cancers with skeletal muscle metastases and specified the histology of the primary tumor. Sixteen of these cases (76%) are adenocarcinomas (2)(3)(4)9,(12)(13)(14)(15)(16)(17)(18)(19)(20), whereas only five (24%) are ESCCs (1,3,21,22). By contrast, 13 cases of ESCC metastatic to myocardium have been reported (11,(23)(24)(25), but no reports of esophageal adenocarcinoma metastatic to myocardium were found.…”