Occult esophageal squamous cell carcinoma with metastases to the spine and central nervous system

Abstract

Esophageal malignancy encompasses a group of diseases that are mostly represented by the squamous cell carcinoma and the adenocarcinoma. Quite frequently, these neoplasms present aggressive behavior; therefore, the diagnosis is often made when the condition is in advanced stages. Dysphagia is the typical clinical complaint, although it is present only when most of the lumen is obstructed. Therefore, quite often, the metastatic disease is first diagnosed, which contributes to the patient's poor survival expectancy. The authors report the case of a 58-year-old man who looked for medical care complaining of a long-term history of scapular pain. The diagnostic work-up disclosed a cervical spine lytic lesion surrounded by a tumoral mass shown by computed tomography. The cervical tumor was sampled by fine needle aspiration, revealing an undifferentiated carcinoma. The outcome was unfavorable and the patient died. The autopsy findings revealed metastatic disease to the spine and central nervous system, and the primary tumor was found to be an esophageal squamous cell carcinoma, which had progressed without typical dysphagia.

Occult Esophageal Squamous Cell Carcinoma Presenting with Multiple Bony Osteolytic Lesions Clinically Mimicking Multiple Myeloma: A Diagnostic Dilemma

“…6 Dysphagia is a typical presentation of esophageal carcinoma present in more than 80% of the cases. 6,7 However, dysphagia occurs only when two-thirds of the esophageal lumen is involved. 7 A deep infiltrating tumor can metastasize to adjacent organs without producing dysphagia.…”

“…Comparison of the present case with some of the cases reported in the literature is enumerated in ►Table 1. 3,[5][6][7][8][9] Cases of occult carcinomas presenting with osteolytic bone metastasis may clinically mimic MM. 3 The diagnosis of MM requires the presence of ≥10% clonal plasma cells in the bone marrow or biopsy proven plasmacytoma along with evidence of end-organ damage such as hyper…”

“… 6 7 However, dysphagia occurs only when two-thirds of the esophageal lumen is involved. 7 A deep infiltrating tumor can metastasize to adjacent organs without producing dysphagia. 3 Cases of esophageal carcinoma presenting with bone pain due to bone metastasis and without any complaint of dysphagia are extremely rare.…”

Intradural extramedullary metastasis: a review of literature and case report

“…The survival rate for esophageal carcinoma is poor, and when metastatic disease is present, the 5-year survival rate is less than 5% [2]. Common sites of metastasis for esophageal carcinoma include lymph node, liver, lung, bone, and brain with known dissemination via contiguous spread, lymphatics, and the blood stream [3]. Although metastasis to the vertebral column occurs in~3-5% of all cancers, it has been rarely reported in the case of a primary esophageal neoplasm [4].…”

Comparing Two Year Survival Rate of Esophageal Cancer Patients with and without Neoadjuvant Chemoradiotherapy Treatment

“…Also, the 3 year mortality rate was higher in patients who had had surgery when compared to subjects who had been treated with radiotherapy [9]. The main reason behind the failure of surgical methods can be pertained to the systemic attributes of esophageal cancer at the time of treatment [10,11]. Early systemic chemotherapy and also local radiotherapy, alongside surgical procedures, help limiting the spread of cancer and thus increase survival rates.…”