A rare case of esophageal metastasis from pancreatic ductal adenocarcinoma: a case report and literature review

Abstract

PurposeWe report a very unique case of an esophageal metastasis from a pancreatic ductal adenocarcinoma (PDAC) primary.MethodsAfter obtaining consent from the patient, all relevant records of the case were obtained and retrospectively reviewed.ResultsAt 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.ConclusionsDifferentiating 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.

Endoscopic ultrasound-guided fine needle aspiration for smooth benign appearing malignant esophageal stricture: a cross-sectional study

“…There are many clinical causes of esophageal stricture, which may be accompanied by dysphagia, vomiting, an inability to eat, and may result in malnutrition. Esophageal Histology only (+) 11 [22] Both (+) 34 [68]…”

“…Metastatic esophageal cancer is very rare clinically. Since the first case of metastatic esophageal cancer from the prostate was reported by Gross et al (16) in 1942, various metastatic esophageal cancers in different organs have been reported, including the breast, lungs, ovary, liver, colon, pancreas, bladder, kidneys, and stomach (17)(18)(19)(20)(21)(22)(23)(24)(25). The most common primary sites for metastatic esophageal cancer are the breast and lungs (17,18).…”

Breast Cancer With Rare Metastatic Manifestation

“…In particular, breast metastases from pancreatic adenocarcinoma are quite uncommon; a few cases are reported in the literature [1,2,9]. Pancreatic ductal adenocarcinoma most commonly metastasizes to lymph nodes, liver, lung and peritoneal cavity, while rarely to the bone, brain, myocardium, umbilicus and esophagus [32].…”