Direct esophageal metastasis from a distant primary tumor is a submucosal process: a review of six cases

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.

Esophageal metastasis of breast carcinoma

“…Based on our review of the literature, the most common site of esophageal involvement is the middle third (16 of 23 cases), which agrees with previous reports [1,7]. The mechanism by which breast cancer spreads to the esophagus has been the subject of debate.…”

“…Among 23 cases, in 11 cases, including our case [8, 13-17, 19, 20], the esophagus was the first recurrent site, and in 7 cases [7,[9][10][11][12][13], it was not the first site of recurrence. In the other five cases [1,18], this detail is not mentioned. A long interval between primary treatment for the breast tumor and its recurrence with esophageal involvement has been reported.…”

“…From the standpoint of metastatic esophageal tumors, the most common malignancy to metastasize to the esophagus is breast carcinoma [3,6,7]. To the best of our knowledge, there have been 23 cases (16 case reports) including our case of esophageal metastasis from breast cancer in the English-language medical literature for the last 20 years [1,[7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Among 23 cases, in 11 cases, including our case [8, 13-17, 19, 20], the esophagus was the first recurrent site, and in 7 cases [7,[9][10][11][12][13], it was not the first site of recurrence.…”

“…The esophagus is a very rare metastatic site of breast cancer, but one of the most common malignancies to metastasize to the esophagus is breast cancer [1,2]. However, autopsy studies have shown that most cases of metastatic breast cancer to the esophagus are subclinical [3,4].…”

Analysis of gastrointestinal metastasis of primary lung cancer: Clinical characteristics and prognosis

“…In such cases, metastatic tumors appear in submucosal locations in the gastrointestinal tract with normal overlying mucosa as a result of lymphatic or bloodstream dissemination to the gastrointestinal tract (13). Therefore, it may be difficult to obtain an accurate diagnosis using a biopsy due to the presence of the overlying mucosa.…”