Rare Presentation of Gastroesophageal Carcinoma with Rectal Metastasis: A Case Report

Abstract

Patient: Female, 60Final Diagnosis: Gastroesophageal carcinoma with rectal metastasisSymptoms: Bloating • constipation • weight lossMedication: —Clinical Procedure: Endoscopy • flexible sigmoidoscopy • lower endoscopic ultrasoundSpecialty: Gastroenterology and HepatologyObjective:Unusual clinical courseBackground:Gastroesophageal cancers, previously considered rare, are rapidly increasing worldwide. We present here a unique case of gastroesophageal carcinoma with metastasis to the rectum.Case Report:A 60-year-old female patient presented with constipation, bloating, and weight loss of 4-month duration. She had undergone sleeve gastrectomy 6 years before. Endoscopies performed revealed a friable-looking mucosa in the lower esophagus and a polypoid rectal mass. Histopathological examination from both the esophageal and rectal lesions revealed poorly differentiated adenocarcinoma cells. Immunohistochemistry stain from both specimens was positive for CK7 supporting the gastric site primary with metastasis to the rectum. Further evaluation also revealed metastasis to bone and malignant pleural effusion. Chemotherapy with palliative intent was initiated.Conclusions:Colorectal metastasis is commonly seen from cancers of the breast, stomach, melanoma, kidney, prostate, and ovaries. However, colorectal metastasis from gastroesophageal cancer has never been reported in the medical literature. Diagnosis relies on histopathologic examination and immunohistochemical staining of the tumor. Treatment depends on the tumor stage. Tumors with widespread metastatic disease are candidates for palliative chemotherapy.

A rare case of colorectal metastasis found 8 years and 10 months after gastrectomy for advanced gastric cancer: A case report and literature review

“…To investigate the characteristics of colon metastasis from gastric cancer, we summarized the reported cases of gastric cancer colon metastasis. Synchronous colorectal metastases differ from metachronous; we found 24 metachronous (1-4,6,14-29) (Table I) and 13 synchronous cases (5,25,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), as classified and listed in Table II. Several reports have set the boundary between synchronous and metachronous metastases as diagnosed after 2 months, 6 months, and 1 year from the primary diagnosis.…”

Case report: A case of rectal metastatic squamous cell carcinoma from the esophagus

“…The English literature (PubMed) search for rare sites of esophageal cancer metastasis from 1982 to February 2017 by Osama Shaheen, excluded common sites of metastasis, i.e., the liver, lung, bone, adrenal gland, and brain, and retrieved 147 papers; 25 rare metastatic sites were identified, of which only 10 cases were reported to involve metastasis to the rectum (5). Jasbir Makker et al reported a case of gastroesophageal junction adenocarcinoma with rectal metastasis in 2016 (6), and Ryohei Ono et al reported a case of small bowel metastasis from lower thoracic esophageal cancer in 2018 (7). The overall prognosis of the patients in the above cases was extremely poor.…”

A Rare Case of Esophageal Adenocarcinoma with Urinary Bladder Metastasis

“…The most common areas of esophageal cancer metastasis are to the liver and peritoneum [6–8], regional lymph nodes, lung, pleura, stomach, kidney, adrenals, and bone [8]. The urinary bladder is an extremely rare site of metastasis.…”

“…There are 5 main routes of metastasis of esophageal and gastric cancer: (1) direct invasion; (2) lymphatic spread; and (3) hematogenous, (4) transperitoneal, and (5) intraluminal implantation [ 6 ]. The most common areas of esophageal cancer metastasis are to the liver and peritoneum [ 6 – 8 ], regional lymph nodes, lung, pleura, stomach, kidney, adrenals, and bone [ 8 ]. The urinary bladder is an extremely rare site of metastasis.…”

“…The high mortality from esophageal cancer is attributed to local invasion and distant spread of this malignancy [ 1 – 5 ]. Metastasis of esophageal cancer usually occurs to regional lymph nodes, lungs, liver, brain, bone, and peritoneum [ 6 , 7 ]. Distant metastasis of esophageal cancer to urinary bladder is extremely rare and has only been reported twice worldwide [ 7 , 8 ].…”