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Tanaka Y, Chino O, Kajiwara H, Hanashi T, Nakamura T, Makuuchi H. A rare case of esophageal metastasis from signet-ring cell carcinoma of the cecum. Surg Case Rep 2023; 9:186. [PMID: 37872388 PMCID: PMC10593686 DOI: 10.1186/s40792-023-01768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023] Open
Abstract
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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Affiliation(s)
- Yoichi Tanaka
- Department of Surgery, Tokai University Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan.
| | - Osamu Chino
- Department of Surgery, Tokai University Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Hiroshi Kajiwara
- Department of Pathology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Tomoko Hanashi
- Department of Surgery, Tokai University Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Tomoki Nakamura
- Department of Surgery, Tokai University Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Hiroyasu Makuuchi
- Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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2
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Da Cunha T, Restrepo D, Abi-Saleh S, Dharan M. Breast cancer metastasizing to the upper gastrointestinal tract (the esophagus and the stomach): A comprehensive review of the literature. World J Gastrointest Oncol 2023; 15:1332-1341. [PMID: 37663940 PMCID: PMC10473935 DOI: 10.4251/wjgo.v15.i8.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/01/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023] Open
Abstract
Breast cancer can infrequently metastasize to the upper gastrointestinal (GI) tract but the exact incidence is not well established-there is considerable variation between incidence reported from clinical studies and incidence noted in autopsy series. Clinical presentation can be very non-specific and often mimics primary gastrointestinal conditions. Endoscopy alone may not be sufficient to make a diagnosis and misdiagnosis is also common. A high degree of awareness and clinical suspicion is required to establish metastases to the upper GI tract. We undertook a comprehensive review of the available literature on breast cancer metastases to the esophagus and stomach including the clinical symptoms and presentation, endoscopic features, additional diagnostic imaging modalities, treatment and outcomes.
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Affiliation(s)
- Teresa Da Cunha
- Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - David Restrepo
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Simon Abi-Saleh
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Murali Dharan
- Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT 06030, United States
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3
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A Rare Case of Esophageal Metastasis of Invasive Mucinous Adenocarcinoma of the Lung. ACG Case Rep J 2022; 9:e00857. [PMID: 36061247 PMCID: PMC9433081 DOI: 10.14309/crj.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
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4
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Cholangiocarcinoma With Rare Esophageal Metastasis. ACG Case Rep J 2022; 9:e00717. [PMID: 35028323 PMCID: PMC8751775 DOI: 10.14309/crj.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
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5
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Ohnita K, Higashi S, Hirai S, Kuwahara A, Kakigao K, Nakashiki S, Inoue K, Kurohama H, Nakashima M, Nakao K. Esophageal metastasis of renal cell carcinoma resected by endoscopic submucosal dissection: a case report. BMC Gastroenterol 2021; 21:348. [PMID: 34544382 PMCID: PMC8454032 DOI: 10.1186/s12876-021-01925-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Esophageal metastasis of renal cell carcinoma (RCC) is extremely rare. We have described herein a case of a 59-year-old man with esophageal metastasis of RCC that was endoscopically resected. Case presentation The case was a 59-year-old man who had undergone left nephrectomy for renal clear cell carcinoma 17 years ago and splenectomy for splenic metastasis 3 years ago. Esophagogastroduodenoscopy (EGD) performed 9 years ago revealed a small reddish elevated lesion with a smooth surface in the middle esophagus; this lesion increased in size 4 years ago. However, no biopsy was performed. The lesion continued to grow in size and was found to have become nodular during the present observation. Biopsy revealed clear cell carcinoma. Endoscopic ultrasound (EUS) revealed that the lesion had not invaded the submucosa, and contrast-enhanced computed tomography did not reveal any other metastasis. The lesion was successfully removed en bloc via endoscopic submucosal dissection (ESD). Pathologically, the tumor was detected in the subepithelium with focal infiltration of the muscularis mucosa. It consisted of monotonous cells with small nuclei and a clear cytoplasm. Immunohistological findings indicated that the tumor was a metastasis of RCC. The lateral and vertical margins were noted to be free. Conclusions We have presented herein a case of esophageal metastasis of RCC that had progressed over 9 years and was then resected en bloc through endoscopic submucosal dissection.
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Affiliation(s)
- Ken Ohnita
- Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12 Takara-machi, Nagasaki, Japan. .,Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Japan.
| | - Shuntaro Higashi
- Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12 Takara-machi, Nagasaki, Japan
| | - Satoshi Hirai
- Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12 Takara-machi, Nagasaki, Japan
| | - Ai Kuwahara
- Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12 Takara-machi, Nagasaki, Japan
| | - Kana Kakigao
- Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12 Takara-machi, Nagasaki, Japan
| | - Suguru Nakashiki
- Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12 Takara-machi, Nagasaki, Japan
| | - Kenichiro Inoue
- Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12 Takara-machi, Nagasaki, Japan
| | - Hirokazu Kurohama
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Japan
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6
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Khalifa A, Broder A. A Rare Case of Synchronous Esophageal and Pancreatic Malignancy. Cureus 2021; 13:e17195. [PMID: 34540423 PMCID: PMC8439344 DOI: 10.7759/cureus.17195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 02/05/2023] Open
Abstract
The incidence of double primary tumors has been rising over the past few decades. Synchronous pancreatic and esophageal carcinomas are rarely reported in the literature. In this case report, we present an 86-year-old man who developed synchronous double cancers of the pancreas and esophagus. He has a past medical history of hypertension and prior nicotine dependence and was admitted for abdominal pain and weight loss. Laboratory data on admission were normal except for the serum carbonic anhydrase 19-9 (54 U/mL, reference range: 0-34 U/mL) and carcinoembryonic antigen (712.4 ng/mL, reference range: less than <5.0 ng/mL). Abdominal ultrasonography revealed a 2.3 cm lesion at the head of the pancreas. A CT scan with contrast was highly suspicious for pancreatic head malignancy. The patient underwent endoscopical ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) that showed a large non-obstructing ulcerating mass at the gastroesophageal junction (GEJ) as well as a pancreatic head mass. Histological findings from the obtained tissue demonstrated pancreatic adenocarcinoma and intestinal-type adenocarcinoma of the esophagus with an invasion of lamina propria, and diagnosis of double cancers of the pancreas and esophagus was made. In conclusion, our case report represents the fifth documented case of dual primary malignancy of the esophagus and pancreas. This highlights that, despite their rarity, primary distant malignancies in patients with pancreatic cancer is an entity that clinicians should be more cognizant about especially among the male smoker/ex-smoker patient population, specifically given that the current data demonstrate that the prognosis of double cancers primarily depends on the prognosis of the pancreatic carcinoma.
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Affiliation(s)
- Ali Khalifa
- Internal Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson School of Medicine, New Brunswick, USA
| | - Arkady Broder
- Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers Robert Wood Johnson School of Medicine, New Brunswick, USA
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7
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Yasuoka S, Yuasa T, Fujiwara M, Fujisaki J, Inamura K, Komai Y, Numao N, Yamamoto S, Yonese J. Unusual metastasis from renal cell cancer after partial nephrectomy and sequential targeted therapy. IJU Case Rep 2021; 4:136-138. [PMID: 33977239 PMCID: PMC8088885 DOI: 10.1002/iju5.12261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/26/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Metastatic renal cell carcinoma is treated with various regimens. As their outcomes are improving and follow-up periods are growing longer, the rate of unusual visceral metastases may increase. CASE PRESENTATION A 68-year-old man diagnosed with lung, pancreatic, and renal metastases 9 years after left partial nephrectomy and a diagnosis of pT1a clear cell renal cell carcinoma started molecular targeted therapy using sunitinib. Nine years after the initiation of targeted therapy, a mass lesion in the esophagus was revealed by follow-up computed tomography, and endoscopic mucosal resection of the esophageal metastatic lesion was performed. One year later, a bladder tumor was detected by follow-up computed tomography. The patient underwent transurethral resection of the bladder tumor. Histological evaluation of both resected specimens disclosed clear cell renal cell carcinoma. CONCLUSION We present a valuable case of metachronous esophagus and bladder metastases from renal cell carcinoma in a long-term follow-up.
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Affiliation(s)
- Shotaro Yasuoka
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Takeshi Yuasa
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Motohiro Fujiwara
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Junko Fujisaki
- Department ofGastroenterological MedicineCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Kentaro Inamura
- Department ofPathologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Yoshinobu Komai
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Noboru Numao
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Shinya Yamamoto
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Junji Yonese
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
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8
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A Path Less Traveled: Metastatic Esophageal Carcinoma from a Primary Ovarian Malignancy. J Gastrointest Cancer 2020; 51:329-331. [PMID: 31155697 DOI: 10.1007/s12029-019-00261-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Lam AKY. Updates on World Health Organization classification and staging of esophageal tumors: implications for future clinical practice. Hum Pathol 2020; 108:100-112. [PMID: 33157124 DOI: 10.1016/j.humpath.2020.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022]
Abstract
The Fifth edition of the World Health Organization classification of digestive system and American Joint Committee on Cancer staging manual contain substantial refinements of information for esophageal tumors. The epithelial tumors of esophagus are classified as benign, dysplasia, and malignant groups. Dysplasia is divided into Barrett dysplasia and squamous dysplasia and graded into either low-grade or high-grade. Malignant esophageal tumors are often adenocarcinoma or squamous cell carcinoma. The main update in cancer staging in esophageal tumors is the subdivision of the prognostic staging into 3 groups; squamous cell carcinoma, adenocarcinoma, and carcinoma after adjuvant therapy. HER-2 amplification is recognized as a molecular target for therapy of esophagogastric adenocarcinoma. The other esophageal tumors are adenoid cystic carcinoma, mucoepidermoid/adenosquamous carcinoma, undifferentiated carcinoma and neuroendocrine neoplasms. Overall, the incorporation of new data and definitions on histopathology, prognostic factors, and genetics are important for personalized management of patients with esophageal tumors.
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Affiliation(s)
- Alfred King-Yin Lam
- School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4209, Australia.
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10
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Businello G, Dal Pozzo CA, Sbaraglia M, Mastracci L, Milione M, Saragoni L, Grillo F, Parente P, Remo A, Bellan E, Cappellesso R, Pennelli G, Michelotto M, Fassan M. Histopathological landscape of rare oesophageal neoplasms. World J Gastroenterol 2020; 26:3865-3888. [PMID: 32774063 PMCID: PMC7385561 DOI: 10.3748/wjg.v26.i27.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
The landscape of neoplastic pathology of the oesophagus is dominated by malignancies of epithelial origin, in particular by oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. However, several other histopathological variants can be distinguished, some associated with peculiar histopathological profiles and prognostic behaviours and frequently underrecognized in clinical practice. The aim of this review is to provide a comprehensive characterization of the main morphological and clinical features of these rare variants of oesophageal neoplastic lesions.
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Affiliation(s)
- Gianluca Businello
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Carlo Alberto Dal Pozzo
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Marta Sbaraglia
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Luca Mastracci
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, First Pathology Division, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Federica Grillo
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Italy
| | - Andrea Remo
- Department of Pathology, Ospedale Mater Salutis di Legnago, Legnago 37045, Italy
| | - Elena Bellan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Rocco Cappellesso
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Gianmaria Pennelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Mauro Michelotto
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
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11
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Esophageal Metastases from Breast Carcinoma: a Rare Delayed Metastases After 15 Years. J Gastrointest Cancer 2020; 50:674-677. [PMID: 29717415 DOI: 10.1007/s12029-018-0109-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Padda MS, Si WM. Rare presentation of renal cell cancer as dysphagia: a case report. J Med Case Rep 2019; 13:89. [PMID: 30885269 PMCID: PMC6423814 DOI: 10.1186/s13256-018-1967-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 12/27/2018] [Indexed: 12/04/2022] Open
Abstract
Background Metastasis from distal solid organs to the esophagus is very rare. Renal cell cancer with esophageal metastasis is extremely rare. We present the first case report of undiagnosed renal cell cancer presenting as dysphagia. Case presentation A 56-year-old Caucasian man presented for dysphagia evaluation. An esophagogastroduodenoscopy examination revealed a 6 mm nodule located at gastroesophageal junction. Pathology and immunohistopathology were suggestive of metastatic renal cell cancer. Abdominal imaging revealed a large renal mass consistent with renal cell cancer. He underwent left nephrectomy and is clinically asymptomatic, while being monitored by Oncology and Urology. Conclusions Undiagnosed renal cell cancer metastasis presenting as dysphagia is very rare. Careful upper endoscopy examination contributed to the diagnosis of this rare entity. A multidisciplinary team approach is key for management of these clinical dilemmas.
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Affiliation(s)
- Manmeet S Padda
- Gastroenterology and Hepatology, DHAT, Scott and White Baylor Medical Center, McKinney, TX, USA.
| | - Wei M Si
- Department of Pathology, AmeriPath, Plano, TX, USA
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13
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Miyake M, Yamada A, Miyake K, Endo I. Esophageal metastasis of breast cancer during endocrine therapy for pleural dissemination 21 years after breast surgery: a case report. Surg Case Rep 2019; 5:22. [PMID: 30771195 PMCID: PMC6377688 DOI: 10.1186/s40792-019-0585-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/06/2019] [Indexed: 12/19/2022] Open
Abstract
Background The esophageal metastasis of breast cancer is rare. Moreover, it is extremely unusual for patients to experience the symptoms of esophageal metastasis during their lifetimes. We present a case of dysphagia caused by esophageal metastasis after a long interval following a primary mastectomy. Case presentation A 77-year-old woman with a history of heterochronous bilateral breast cancer and under treatment for pleural dissemination recurrence originating from right breast cancer complained of dysphagia. At the age of 56, she had undergone a right radical mastectomy for right breast cancer. The histopathological findings revealed invasive ductal carcinoma, pT3N1M0, which was estrogen receptor (ER)- and progesterone receptor (PgR)-positive. At the age of 73, she underwent a second operation, a left modified radical mastectomy. The histopathological examination revealed invasive ductal carcinoma, pT1N0M0, which was negative for ER, PgR, and human epidermal growth factor receptor 2 (HER2). Four years after completion of adjuvant therapy for the left breast cancer, pleural effusion on her left side was observed and histopathological examination of a sample revealed pleural dissemination resulting from the right breast cancer. After initiation of therapy for recurrence, she developed dysphagia and, therefore, underwent an upper gastrointestinal tract endoscopic examination. The examination revealed whole circumferential stenosis and a band unstained by Lugol’s solution located 30 cm from her incisors. Examination of a biopsy specimen revealed a subepithelial luminal structure and dysplastic cells. Immunostaining was positive for CK7 and negative for CK20; furthermore, the sample was ER and PgR-positive. Considering the pathological findings, the patient was diagnosed with esophageal metastasis of her right breast cancer. Conclusions Metastatic lesions in the esophagus are often located in the submucosa; therefore, they may not be definitively diagnosed by histopathological examination of mucosal biopsy specimens. Esophageal metastasis originating from breast cancer often occurs as a part of multiple organ metastases; however, esophageal metastasis is usually not considered a prognostic factor for patients. Therefore, treatment should be determined according to the severity of the other metastatic sites and the degree of esophageal stenosis.
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Affiliation(s)
- Masuyo Miyake
- Department of Breast Surgery, Chigasaki Municipal Hospital, Honson 3-5-1, Chigasaki, Kanagawa, 253-0042, Japan.,Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
| | - Akimitsu Yamada
- Department of Breast Surgery, Chigasaki Municipal Hospital, Honson 3-5-1, Chigasaki, Kanagawa, 253-0042, Japan. .,Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan.
| | - Kentaro Miyake
- Department of Breast Surgery, Chigasaki Municipal Hospital, Honson 3-5-1, Chigasaki, Kanagawa, 253-0042, Japan.,Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
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14
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Metastasis of Hepatocellular Carcinoma to the Esophagus: Case Report and Review. Case Rep Surg 2018; 2018:8685371. [PMID: 30319830 PMCID: PMC6167577 DOI: 10.1155/2018/8685371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/04/2018] [Accepted: 09/02/2018] [Indexed: 02/07/2023] Open
Abstract
A follow-up endoscopy in a 71-year-old Japanese man who had undergone a left lateral segmentectomy for HCC two years ago revealed an approximately 2 cm in diameter pedunculated polypoid mass in the middle part of the thoracic esophagus. Immunohistochemical staining of the endoscopic biopsy revealed a metastatic HCC esophageal tumor. As the patient's disease could be radically removed by preoperative examinations, we resected the metastatic esophageal tumor via right thoracotomy and esophagogastrostomy reconstruction. Histological examination of the resected specimen revealed that the esophageal tumor was compatible with a HCC metastasis. This is an extremely rare case of a solitary metastasis to the esophagus from HCC in the literature.
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15
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Ali S, Atiquzzaman B, Krall K, Kumar R, Liu B, Hebert-Magee S. Not Your Usual Suspect: Clear Cell Renal Cell Carcinoma Presenting as Ulcerative Esophagitis. Cureus 2018; 10:e2821. [PMID: 30131915 PMCID: PMC6101459 DOI: 10.7759/cureus.2821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Renal cell carcinoma (RCC) has the propensity to hematogenously metastasize to the lung, bone, or liver, however, metastasis to the esophagus is exceedingly rare. We report a case of ulcerative esophagitis secondary to recurrent metastatic renal cell cancer status post remote nephrectomy. An 82-year-old Caucasian male presented with dark tarry stools for two days, progressive dysphagia to solid food for several weeks and unintentional weight loss. His past medical history was significant for hypertension, diverticulosis and right-sided renal cell cancer for which he underwent nephrectomy 13 years ago. Physical examination was unremarkable. Laboratory data showed hemoglobin of 12.5 g/dL, with normal platelet count and an international normalized ratio (INR). His stools were positive for occult blood. Esophagogastroduodenoscopy (EGD) revealed a fragile mid esophageal mass and antral erosive gastritis which were both biopsied. Colonoscopy showed diverticulosis without stigmata of active gastrointestinal (GI) bleed. CT scan (computed tomography) of the chest showed a solid esophageal mass in the lower esophagus as well as a right upper lobe lung mass for which CT-guided needle biopsy was obtained. The histopathology revealed metastatic renal cell cancer of clear cell subtype. The patient was started on palliative radiotherapy. On completion of radiotherapy two months later, his dysphagia had resolved. The patient is currently on chemotherapy with Sunitinib. Metastatic involvement of esophagus is relatively uncommon and is reported in 6% of patients with metastatic lung, breast and prostate cancer. Esophageal metastasis of clear cell RCC is very rare and so far only seven cases have been reported. Diagnosis is confirmed by endoscopy, imaging and histopathology. Treatment options include surgical or endoscopic resection for a solitary metastatic lesion. If the tumor is unresectable, multidisciplinary treatment including radiation and chemotherapy is indicated.
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Affiliation(s)
- Saeed Ali
- Internal Medicine Residency, Florida Hospital, Orlando, USA
| | | | - Konrad Krall
- Center for Interventional Endoscopy, Florida Hospital, Orlando, USA
| | - Ranjeet Kumar
- Internal Medicine Residency, Florida Hospital, Orlando, USA
| | - Bo Liu
- Diagnostic Radiology, Florida Hospital, Orlando, USA
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16
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Teh GXJ, Tan D, Khor JL, Wan WK, Wang YT. Esophageal Metastatic Adenocarcinoma Diagnosed with Endoscopic Ultrasound. Case Rep Gastroenterol 2017; 11:694-700. [PMID: 29430220 PMCID: PMC5803709 DOI: 10.1159/000484133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/10/2017] [Indexed: 12/27/2022] Open
Abstract
Metastasis to the esophagus from a distant primary cancer is a rare manifestation in a patient with a history of oncological disease presenting with obstructive upper gastrointestinal symptoms. Computed tomography of the thorax or esophagogastroduodenoscopy can be non-diagnostic as the disease tends to be submucosal. In such a situation, endoscopic ultrasound (EUS) with fine needle aspiration (FNA) can be directed to characterize and sample the submucosal esophageal lesion. We present a case series of metastatic esophageal strictures diagnosed with EUS and FNA.
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Affiliation(s)
| | - Damien Tan
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Jen Lock Khor
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Wei Keat Wan
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Yu Tien Wang
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
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17
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Zanghì S, Siboni S, Asti E, Festa A, Bonavina L. Metastasis to the esophagus from primary adenocarcinoma of the lung. Eur Surg 2017. [DOI: 10.1007/s10353-017-0501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Rosati LM, Kummerlowe MN, Poling J, Hacker-Prietz A, Narang AK, Shin EJ, Le DT, Fishman EK, Hruban RH, Yang SC, Weiss MJ, Herman JM. A rare case of esophageal metastasis from pancreatic ductal adenocarcinoma: a case report and literature review. Oncotarget 2017; 8:100942-100950. [PMID: 29246032 PMCID: PMC5725074 DOI: 10.18632/oncotarget.18458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/20/2017] [Indexed: 02/07/2023] Open
Abstract
Purpose We report a very unique case of an esophageal metastasis from a pancreatic ductal adenocarcinoma (PDAC) primary. Methods After obtaining consent from the patient, all relevant records of the case were obtained and retrospectively reviewed. Results At presentation, the patient was diagnosed with synchronous pancreatic and esophageal cancer. He received six months of neoadjuvant therapy including FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and stereotactic body radiation therapy (SBRT) to the pancreatic tumor followed by a combined pancreaticoduodenectomy and Ivor Lewis esophagectomy. Review of the final esophageal specimen revealed normal overlying squamous mucosa with an underlying focus of metastatic PDAC. The patient remains alive with no evidence of disease 17 months from surgery and 25 months from diagnosis. Conclusions Differentiating an esophageal metastasis from a PDAC primary versus a synchronous esophageal carcinoma is very difficult despite state-of-the-art diagnostic techniques performed at a high-volume tertiary cancer center. Extensive evaluation and continued follow-up of PDAC patients presenting with a synchronous esophageal lesion in a multidisciplinary setting may help ensure efficient and accurate management. In our case, neoadjuvant FOLFIRINOX and SBRT to the primary PDAC tumor followed by surgery has been an effective approach for this patient.
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Affiliation(s)
- Lauren M Rosati
- Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan N Kummerlowe
- Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin Poling
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Hacker-Prietz
- Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amol K Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eun J Shin
- Department of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dung T Le
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elliot K Fishman
- Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Yang
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Weiss
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M Herman
- Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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19
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Watanabe S, Takashima A, Taniguchi H, Tanaka Y, Nakamura S, Okita N, Honma Y, Iwasa S, Kato K, Hamaguchi T, Boku N. Esophageal Metastasis from Rectal Cancer Successfully Treated with Fluorouracil-Based Chemotherapy with Bevacizumab: A Case Report and Review of the Literature. Case Rep Oncol 2017. [PMID: 28626398 PMCID: PMC5471784 DOI: 10.1159/000474939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Esophageal metastasis from colorectal carcinoma is uncommon, and diagnosis of esophageal metastasis is difficult. We report a case of a 54-year-old woman with postoperative recurrence of rectal cancer metastasizing to the esophagus. She underwent rectectomy and adjuvant chemotherapy with fluorouracil, leucovorin plus oxaliplatin for stage IIIB rectal cancer. Three years later, she presented with dysphagia and cough. Computed tomography showed thickening of the esophagus wall, enlargement of the lymph nodes in the mediastinum and abdomen, and ground-glass opacities in the right lung. Endoscopy revealed a submucosal tumor of the midthoracic esophagus. Histopathological analysis of the tumor biopsy showed infiltration of adenocarcinoma cells into the stroma of the esophagus; tumor cells were positive for caudal type homeobox 2 and negative for thyroid transcription factor 1. A transbronchial biopsy indicated pulmonary lymphangitic carcinomatosis of rectal adenocarcinoma. Based on those findings, she was diagnosed with recurrent rectal cancer. She received fluorouracil-based chemotherapy plus bevacizumab, which ameliorated her symptoms and induced a durable response without severe adverse events. Diagnosis of esophageal metastasis from rectal cancer can thus be made by repeated biopsy. Furthermore, aggressive systemic treatment with fluorouracil-containing chemotherapy and bevacizumab is a treatment option for colorectal cancer patients with esophageal metastasis.
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Affiliation(s)
- Sho Watanabe
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Taniguchi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Yusaku Tanaka
- Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Shoko Nakamura
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Natsuko Okita
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshitaka Honma
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Iwasa
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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20
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Breast cancer recurrence in esophagus, stomach, and liver, 15 years following primary surgery: report of a case. Int Cancer Conf J 2015. [DOI: 10.1007/s13691-014-0193-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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21
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Maines F, Caffo O, Veccia A, Galligioni E. Gastrointestinal metastases from prostate cancer: a review of the literature. Future Oncol 2015; 11:691-702. [DOI: 10.2217/fon.14.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
ABSTRACT The availability of active new drugs for the treatment of advanced castration-resistant prostate cancer has significantly prolonged overall survival, thus changing the natural history of the disease and raising the likelihood of observing metastases in atypical sites. This review of the literature describes the frequency, clinical-pathological features and presenting symptoms of non-liver gastrointestinal metastases (GIm) from prostate cancer. Its purpose is to increase clinical awareness of the increasing incidence of such GIm, contributing to the early detection, accurate diagnosis and, when feasible, appropriate management.
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Affiliation(s)
- Francesca Maines
- Medical Oncology Department, S Chiara Hospital, Largo Medaglie d'Oro 1, 38100 Trento, Italy
| | - Orazio Caffo
- Medical Oncology Department, S Chiara Hospital, Largo Medaglie d'Oro 1, 38100 Trento, Italy
| | - Antonello Veccia
- Medical Oncology Department, S Chiara Hospital, Largo Medaglie d'Oro 1, 38100 Trento, Italy
| | - Enzo Galligioni
- Medical Oncology Department, S Chiara Hospital, Largo Medaglie d'Oro 1, 38100 Trento, Italy
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22
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Abstract
The patient was a 65-year-old man, who had undergone right nephrectomy for renal cancer in 2002. At that time, histopathological examination revealed clear cell carcinoma (pT3a, pN0, M0, and pStage III). Postoperatively, he received natural interferon alpha (6 million units 3 times a week) from November 2002 to February 2005, and showed no evidence of recurrence. However, he noticed dysphagia in March 2012. Endoscopy revealed a pedunculated polypoid tumor in the mid-esophagus and biopsies were taken showing a clear cell carcinoma. Contrast-enhanced thoracoabdominal CT scanning identified a pedunculated polypoid tumor in the mid-thoracic esophagus and enlargement of a lymph node adjacent to the right main bronchus. With a diagnosis of esophageal and lymph node metastases of renal cancer, the patient underwent esophagectomy with right thoracotomy with reconstruction by a posterior mediastinal stomach tube. Postoperative histopathological examination revealed clear cell carcinoma. Because esophageal metastasis of renal cancer is extremely rare, this case is reported here together with discussions of the relevant literature.
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23
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24
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Bhurgri H, Samiullah S, Dave V, Lenza C. Hard to swallow: colonic adenocarcinoma in esophagus. Gastrointest Endosc 2014; 79:696-8. [PMID: 24630089 DOI: 10.1016/j.gie.2013.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 11/21/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Hadi Bhurgri
- Department of Medicine-Gastroenterology, Rutgers University-New Jersey Medical School, Newark, New Jersey, USA
| | - Sami Samiullah
- Department of Medicine-Gastroenterology, Rutgers University-New Jersey Medical School, Newark, New Jersey, USA
| | - Vinnidhy Dave
- Department of Medicine-Gastroenterology, Rutgers University-New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher Lenza
- Department of Gastroenterology, VA New Jersey Health Care System, East Orange, New Jersey, USA
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25
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Kashiwagi S, Onoda N, Asano Y, Noda S, Kawajiri H, Takashima T, Ishikawa T, Hirakawa K. A rare recurrence of bilateral breast cancer in the esophagus coincidentally associated with primary gastric cancer: a case report. J Med Case Rep 2014; 8:58. [PMID: 24533645 PMCID: PMC3930013 DOI: 10.1186/1752-1947-8-58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 12/23/2013] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Cases of esophageal metastasis of breast cancer are extremely rare. We present the case of a patient who developed recurrence as esophageal metastasis following treatment of bilateral breast cancer. Early-stage gastric cancer was also found coincidentally. CASE PRESENTATION An 86-year-old Japanese female patient with a history of bilateral breast cancer was found to have a gastric mass on a medical examination. At 72 years of age, she had undergone a total mastectomy with level II axillary lymph node dissection (pT3N0M0 stage II). Left breast cancer was found at the age of 79. A total mastectomy was performed with level II axillary lymph node dissection (pT1N0M0 stage I). At the time of her current admission, our patient complained of dysphagia. A repeat gastrofiberscopy revealed a submucosal lesion in her middle esophagus, located 27cm distal to her incisors, as well as a known type I tumor of the gastric cardia. Computed tomography showed a mass lesion in her middle esophagus that had grown extraluminally and infiltrated the tracheal bifurcation and her left primary bronchus. A boring biopsy of the esophageal lesion was performed under ultrasonic monitoring, and a pathological diagnosis of poorly differentiated adenocarcinoma of the esophagus was obtained. The biopsy of the cardiac lesion revealed moderately differentiated adenocarcinoma of the stomach. The expression status of her hormone receptors indicated that the esophageal lesion reflected metastatic recurrence of her breast cancer with coincidental primary gastric cancer (cT1N0M0 stage IA). CONCLUSIONS Esophageal metastasis of breast cancer is extremely rare. An individualized treatment plan combining multimodal approaches should therefore be devised according to the patient's status.
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Affiliation(s)
- Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Yuka Asano
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Satoru Noda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Hidemi Kawajiri
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Tetsuro Ishikawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
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26
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Aulakh KS, Chisholm CD, Smith DA, Speights VO. TTF-1 and napsin A do not differentiate metastatic lung adenocarcinomas from primary esophageal adenocarcinomas: proposal of a novel staining panel. Arch Pathol Lab Med 2013; 137:1094-8. [PMID: 23899066 DOI: 10.5858/arpa.2012-0305-oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT When adenocarcinomas arise within the esophagus, particularly when located away from the gastroesophageal junction, it may be important in some patients to differentiate between a primary esophageal adenocarcinoma and metastasis from another site. Lung adenocarcinoma is one tumor that has been reported to frequently metastasize to the esophagus. OBJECTIVES To create a panel of immunohistochemical markers that can reliably distinguish between an esophageal and pulmonary primary; within the gastrointestinal pathology literature, including published articles and textbooks, common lung immunohistochemical markers, such as TTF-1, are assumed to be negative in esophageal adenocarcinoma, yet, to our knowledge, no study has yet investigated the veracity of that presumption. DESIGN In this study, 24 cases each of pulmonary and esophageal adenocarcinomas were stained with TTF-1, napsin A, CDX2, 34βE12, N-cadherin, and IMP3 in an attempt to define an optimal panel for differentiation. Esophageal adenocarcinomas occurring at the gastroesophageal junction were excluded in this study because a gastric primary tumor cannot be excluded in those cases. RESULTS Surprisingly, TTF-1 and napsin A were positive in similar proportions of tumors from both sites. Those markers that differentiated statistically between esophageal and pulmonary adenocarcinoma were IMP3, CDX2, and N-cadherin. CONCLUSIONS When differentiating the origin of a tumor as either esophageal or pulmonary, an immunohistochemical panel consisting of IMP3, CDX2, and N-cadherin is superior to either TTF-1 or napsin A.
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27
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Hung SH, Tsai MC, Liu TC, Lin HC, Chung SD. Routine endoscopy for esophageal cancer is suggestive for patients with oral, oropharyngeal and hypopharyngeal cancer. PLoS One 2013; 8:e72097. [PMID: 23977217 PMCID: PMC3744481 DOI: 10.1371/journal.pone.0072097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 07/07/2013] [Indexed: 02/06/2023] Open
Abstract
Background This study attempted to reveal the incidence and risk of synchronous and metachronous esophageal cancer in subjects with oral, oropharyngeal and hypopharyngeal cancer based on a population-wide database in Taiwan. Methods We retrieved data for this cross-sectional study from the Taiwanese Longitudinal Health Insurance Database 2000. The study group included 2,965 subjects who had received their first-time diagnosis of oral/oropharyngeal/hypopharyngeal cancer in 2002∼2009. We assigned the date of their first diagnosis of oral/oropharyngeal/hypopharyngeal cancer as the index date. We also randomly retrieved 29,650 comparison subjects matched with the study subjects in terms of gender and age group. We assigned their first medical utilization that occurred in the index year as the index date for the comparison group. We further performed a conditional logistic regression to investigate the association between esophageal cancer and oral cancer. Results Results showed that prevalences of esophageal cancer within 3 months before and after the index date were respectively 2.19% and 0.04% for the study and comparison groups. A conditional logistic regression revealed that the odds ratio (OR) of esophageal cancer for subjects with oral/oropharyngeal/hypopharyngeal cancer was 55.33 (95% confidence interval (CI): 29.86∼102.52) compared to comparison subjects. Furthermore, compared to comparison subjects, ORs for esophageal cancer were respectively 18.41 (95% CI: 8.50–39.85), 40.49 (95% CI: 15.11∼108.64), and 240.96 (95% CI: 125.49–462.69) for study subjects with a malignancy of the oral cavity, oropharynx, and hypopharynx. Conclusion We concluded that there were relatively high chances for synchronous and metachronous esophageal cancers being detected through panendoscopy in patients with oral, oropharyngeal, and hypopharyngeal cancers. The routine use of panendoscopy in such patients should be encouraged with a higher priority.
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Affiliation(s)
- Shih-Han Hung
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
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28
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Vashi PG, Gupta D, Tan B. Colon carcinoma with unusual metastasis to the esophagus manifesting as multiple nodules and Dysphagia: management with systemic chemotherapy. Case Rep Gastroenterol 2012; 6:484-8. [PMID: 22855665 PMCID: PMC3409515 DOI: 10.1159/000341587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We present here the rare clinical case of a 44-year-old gentleman with metastasis from colon carcinoma to the esophagus presenting with multiple nodules and dysphagia, which was successfully managed with systemic chemotherapy. The patient presented at our institution with 3-month history of dysphagia almost 4 years after being operated for stage III carcinoma in the sigmoid colon. Endoscopic findings showed multiple nodules at the gastroesophageal junction and mid esophagus. Histological features and immunostains confirmed the diagnosis of metastatic colon carcinoma. Because of evidence of extensive metastatic disease in the spine and liver requiring systemic therapy, the patient was treated with chemotherapy with irinotecan and cetuximab, with subsequent improvement in tumor markers, liver metastasis and symptoms of dysphagia. Even though repeat endoscopy showed no improvement in esophageal nodules, the overall response to chemotherapy was positive. In conclusion, we present a very rare, previously unreported case of metastases from colon cancer to the esophagus presenting as non-obstructive nodules and dysphagia that responded to systemic chemotherapy.
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Affiliation(s)
- Pankaj G Vashi
- Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, Ill., USA
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29
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Boonnuch W, Akaraviputh T, Nino C, Yiengpruksawan A, Christiano AA. Successful treatment of esophageal metastasis from hepatocellular carcinoma using the da Vinci robotic surgical system. World J Gastrointest Surg 2011; 3:82-5. [PMID: 21765971 PMCID: PMC3135873 DOI: 10.4240/wjgs.v3.i6.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 04/02/2011] [Accepted: 04/09/2011] [Indexed: 02/06/2023] Open
Abstract
A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma (HCC) presented with progressive dysphagia. He had undergone liver transplantation for HCC three and a half years prevously. At presentation, his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus, causing a luminal stricture. We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system. Recovery was uneventful and he was been doing well 2 mo after surgery. α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively. During the follow-up period, he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation.
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Affiliation(s)
- Wiroon Boonnuch
- Wiroon Boonnuch, Thawatchai Akaraviputh, Minimally Invasive Surgery Center, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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30
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Padda MS, Siddiqui UD. A rare cause of dysphagia. Gastroenterology 2010; 139:e3-4. [PMID: 20639075 DOI: 10.1053/j.gastro.2009.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 08/07/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Manmeet S Padda
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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31
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Hsu PK, Shai SE, Wang J, Hsu CP. Esophageal metastasis from occult lung cancer. J Chin Med Assoc 2010; 73:327-30. [PMID: 20603092 DOI: 10.1016/s1726-4901(10)70070-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 03/22/2010] [Indexed: 11/26/2022] Open
Abstract
A 66-year-old man with dysphagia was found to have a poorly differentiated esophageal carcinoma by incision biopsy. Following esophagectomy, reconstruction with a gastric tube was performed. Pathological examination and immunohisto-chemistry showed infiltration of adenocarcinoma cells with positive thyroid transcription factor 1-staining in the submucosal layer, which indicated metastatic esophageal carcinoma. Although no pulmonary lesion could be visualized by imaging or bronchoscopy, pulmonary origin was highly suspected as a result of positive thyroid transcription factor 1-staining. To the best of our knowledge, this is the first reported case of metastatic esophageal carcinoma from occult lung cancer (AJCC TNM stage TX).
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Affiliation(s)
- Po-Kuei Hsu
- Department of Surgery, Chutung Veterans Hospital, Hsinchu, Taipei, Taiwan, ROC.
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33
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Pancreatic head cancer with distant duodenal metastasis: a case report with rare endoscopic presentations. Am J Med Sci 2009; 338:75-7. [PMID: 19474654 DOI: 10.1097/maj.0b013e31819d5eac] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Metastasis to the duodenum from a primary cancer is rare, but direct extension from pancreatic cancer is much more common. Here, we present a case of multiple duodenal metastases of pancreatic head cancer in a 77-year-old woman with upper gastrointestinal bleeding. An upper gastrointestinal endoscopic examination revealed multiple elevated reddish nodules on a normal mucosa background that extended from the superior duodenal angle to the duodenal second portion. Echo-guided fine needle aspiration biopsies of the pancreatic head tumor and endoscopic biopsies of the reddish duodenal nodules proved the diagnosis of adenocarcinoma. When such endoscopic morphology is found, especially when the locations are distant from the papillae, metastasis should be considered and multiple biopsies are mandatory.
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34
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Wada Y, Harada N, Ohara K, Kawata H, Iwasaki H, Kawamura Y, Gomi T, Ohtoshi M, Nakashima Y. Esophageal metastasis of breast carcinoma. Breast Cancer 2008; 16:151-6. [PMID: 18762863 DOI: 10.1007/s12282-008-0068-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Accepted: 07/22/2008] [Indexed: 01/27/2023]
Abstract
Esophageal metastasis from primary breast cancer is an unusual manifestation. We recently treated a patient with dysphagia, whose breast cancer had been treated in the distant past. A 70-year-old woman had been followed regularly in our outpatient clinic for 14 years after her primary breast cancer treatment, with no apparent tumor recurrence. After 2 years absence, she consulted our clinic with progressive dysphagia. Contrast esophagography and endoscopic examination with ultrasonography revealed a protruding submucosal tumor that was histopathologically diagnosed as esophageal metastasis of breast cancer. Radiation therapy involving a total of 60 Gy in combination with aromatase inhibitor was given. The patient's dysphagia was greatly relieved, concomitant with marked improvement of the stenotic lesion on imaging. Since treatment for recurrent breast cancer is generally palliative, systemic (chemo- and/or endocrine-) therapy in combination with radiotherapy is the first-line option for esophageal metastasis of breast cancer.
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Affiliation(s)
- Yasuo Wada
- Department of Surgery, NHO Himeji Medical Center, 68 Honmachi, Himeji, Hyogo, 670-8520, Japan.
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35
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Abstract
Metastasis to the oesophagus is most frequently described in association with lung or breast cancer. Diagnosis is frequently complicated as often only normal tissue is present in endoscopic biopsy specimens. Although oesophagectomy for metastasis has been described, few patients are suitable for curative resection. We report the case of a 62-year-old man who developed an oesophageal metastasis from colorectal cancer and review the available literature.
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Affiliation(s)
- Sarah C Thomasset
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
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36
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Kovács O, Kotsis L, Krasznai G. [Solitary oesophageal metastasis of breast cancer after 17 years latency]. Magy Seb 2007; 60:307-9. [PMID: 18065370 DOI: 10.1556/maseb.60.2007.6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors discuss a case of a 63-year-old woman, who presented with dysphagia, 17 years after radical mastectomy for breast cancer. CT scan showed a juxta esophageal mediastinal tumour. A biopsy via right thoracotomy revealed a metastatic adenocarcinoma of the oesophageal wall from the previous breast carcinoma. Minimally invasive oesophageal intubation was used for palliation. Hormonal manipulation and radiotherapy was commenced postoperatively. The patient was well after eight months follow-up. A combination of high clinical suspicion with EUS and deep oesophageal biopsy can lead to the correct diagnosis of this very rare clinical entity. The biology of metastatic breast cancer may demand palliation by oesophageal intubation or stenting combined with adjuvant chemo, radio or hormonal therapy in such instances.
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Wei SC, Su WC, Chang MC, Chang YT, Wang CY, Wong JM. Incidence, endoscopic morphology and distribution of metastatic lesions in the gastrointestinal tract. J Gastroenterol Hepatol 2007; 22:827-31. [PMID: 17565636 DOI: 10.1111/j.1440-1746.2006.04532.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Metastasis rarely occurs in the gastrointestinal tract (GIT). However, as progress regarding the treatment of cancers has occurred over recent years, the survival time of patients affected by advanced-stage cancers has increased. It could be expected that progressively more cancer patients with gastrointestinal symptoms would be presenting to gastroenterologists for diagnosis and further management. The aim of this study was to reveal the incidence, typical location and morphology of secondary tumors within the GIT. METHODS A retrospective study was conducted at the National Taiwan University Hospital from 1 January 1994 to 31 December 2003 inclusive in order to review the available data pertaining to diagnosed GIT metastases. Only those patients who had been checked by endoscopy and confirmed by histopathology were included. Details regarding patient clinical information, demographic data, treatment, histopathology, and eventual outcome were reviewed, recorded and analyzed. RESULTS The incidence of GIT metastases was found to be one upper GIT metastasis per 3847 upper GIT endoscopies and one lower GIT metastasis per 1871 colonoscopies. The common locations for metastases to occur were duodenum and stomach. The general morphology of the observed metastatic lesions of the digestive tract identified them, mostly, as single and primary (mucosa-origin) carcinoma-like lesions. The survival interval from the diagnosis of GIT metastasis to patient death was statistically significantly longer in the aggressive-treatment group compared to the conservative-treatment group (Kaplan-Meier, P = 0.0004). CONCLUSIONS Although metastatic lesions in the GIT are rare, they do occur. They usually present as single and primary carcinoma-like lesions, with the stomach and duodenum most commonly involved.
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Affiliation(s)
- Shu-Chen Wei
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Sobel JM, Lai R, Mallery S, Levy MJ, Wiersema MJ, Greenwald BD, Gunaratnam NT. The utility of EUS-guided FNA in the diagnosis of metastatic breast cancer to the esophagus and the mediastinum. Gastrointest Endosc 2005; 61:416-20. [PMID: 15758913 DOI: 10.1016/s0016-5107(04)02759-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Breast cancer can metastasize to the esophagus and the mediastinum. EUS-guided FNA (EUS-FNA) is being used increasingly as a less invasive alternative to mediastinoscopy for procuring a tissue diagnosis of mediastinal disease and may be useful for the diagnosis of breast cancer metastatic to the esophagus and the mediastinum. METHODS Twelve women (age range 54-82 years) with a history of breast cancer presented with dysphagia or other symptoms between 1 and 15 years after initial diagnosis and treatment. CT and endoscopy with biopsies suggested a mediastinal mass or lymphadenopathy with extrinsic esophageal compression but failed to provide a tissue diagnosis. EUS-FNA was performed for diagnosis. RESULTS Cytologic evaluation of specimens obtained by EUS-FNA confirmed breast cancer metastases in 11 of 12 patients (91%). Recurrent disease was found in intramural masses and periesophageal lymph nodes. No complication resulted from any EUS-FNA procedure. CONCLUSIONS EUS-FNA is safe and effective for the diagnosis of breast cancer metastases to the esophagus and the mediastinum. EUS-FNA may be useful as a first-line method of evaluation when breast cancer metastasis to the esophagus and the mediastinum is suspected.
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Affiliation(s)
- Jason M Sobel
- Department of Internal Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI 48106, USA
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Haney JC, D'Amico TA. Transhiatal esophagogastrectomy for an isolated ovarian cancer metastasis to the esophagus. J Thorac Cardiovasc Surg 2004; 127:1835-6. [PMID: 15173754 DOI: 10.1016/j.jtcvs.2004.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- John C Haney
- Duke University Medical Center, Durham, NC 27710, USA
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Erman M, Karaoğlu A, Oksüzoğlu B, Aydingöz U, Ayhan A, Güler N. Solitary esophageal metastasis of breast cancer after 11 years: a case report. Med Oncol 2003; 19:171-5. [PMID: 12482128 DOI: 10.1385/mo:19:3:171] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A patient with dysphagia and a history of breast cancer 11 yr ago was admitted to the hospital. A tumor presumably originating from the esophagus was detected. It could not be surgically removed and biopsy revealed adenocarcinoma. The patient received radiotherapy and chemotherapy consisting of etoposide, adriamycin, and cisplatin. An unexpectedly good response was achieved and the possibility of metastatic breast cancer was reinvestigated. Biopsy specimens showed positive estrogen and progesterone receptor staining. Tamoxifen treatment was started. The patient is well after 5 yr following relapse. Solitary esophageal metastasis of breast cancer is a rare event, especially after a remission period lasting more than a decade. Dysphagia in breast cancer patients should raise the suspicion of metastatic disease as well as esophageal cancer and benign strictures.
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Affiliation(s)
- Mustafa Erman
- Department of Medical Oncology, Faculty of Medicine, Institute of Oncology, Hacettepe University, Sihhiye, Ankara, Turkey
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Simchuk EJ, Low DE. Direct esophageal metastasis from a distant primary tumor is a submucosal process: a review of six cases. Dis Esophagus 2002; 14:247-50. [PMID: 11869331 DOI: 10.1046/j.1442-2050.2001.00195.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Malignant esophageal stricture secondary to invasion from a tumor arising in a contiguous organ is a relatively rare finding; even more uncommon is a direct metastasis to the esophagus from a distant primary carcinoma. We present six cases, the largest current series, of esophageal strictures secondary to metastases from a separate primary cancer. We reviewed the records of 20 patients treated at Virginia Mason Medical Center between 1972 and 2000 with a diagnosis of malignant esophageal stricture secondary to an extraesophageal primary carcinoma. Patients whose stricture appeared to be secondary to esophageal invasion or compression from a contiguous tumor or lymph nodes were excluded. The remaining six patients who had metastases to the esophagus itself were reviewed with respect to the nature of the primary tumor, presentation, radiologic and endoscopic findings, and treatment. Among the 20 patients reviewed, 14 were excluded owing to either contiguous involvement from a nearby primary malignancy, regional nodal involvement, or complications of external beam radiation treatment. Six patients were considered to have direct metastasis to the esophagus from distant primary malignancies. The mean age of these patients was 72 years (range 68-74). Two of the primary lesions were lung carcinoma, while four primaries were breast cancers. The average time interval from the diagnosis of a primary tumor to esophageal involvement was 7 years in patients with breast cancer and 5 months in patients with lung cancer. Three patients were palliated with endoscopic dilation and stent placement. The other three patients have died secondary to upper gastrointestinal bleeding. Metastatic cancer to the esophagus is a rare occurrence. The process is usually submucosal and can be difficult to diagnose. The diagnosis should be considered when a patient presents with malignant dysphagia and has a background of distant carcinoma.
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Affiliation(s)
- E J Simchuk
- Department of General and Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA 98111-0900, USA
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