Skeletal muscle metastasis from signet ring cell esophageal adenocarcinoma

Abstract

Symptomatic skeletal muscle metastasis from esophageal adenocarcinoma is rare. Here we report the case of a 49-year-old man who presented with right thigh pain, and was found to have symptomatic psoas muscle metastasis as the presentation of esophageal adenocarcinoma. The primary tumor was notable for signet ring cells (SRC), a poor prognostic indicator as well as a predictor of biologic aggressiveness. The patient passed away within 1 month of diagnosis due to disease progression, supporting the aggressiveness of such SRC esophageal lesions. Lastly, a literature review reveals a differential pattern of metastatic spread between esophageal adenocarcinomas and squamous cell carcinomas as regards muscle metastases. Skeletal muscle metastases are more likely to be due to esophageal adenocarcinoma, whereas myocardial metastases are almost exclusively due to esophageal squamous cell carcinoma (ESCC). These differences may represent an example of the 'seed and soil' hypothesis of metastasis.

Metastatic Signet Ring Cell Adenocarcinoma Manifesting as Chronic Leg Pain

“…9 Although the mechanism of SRCC metastasis to skeletal and cardiac muscle is unclear, it is thought to occur through hematogenous spread of tumor, particularly because these tissues are well-vascularized. 8 Of note, the paravertebral muscles are the most frequently involved site of muscle metastases from a gastric primary. 10 Although gastrointestinal endoscopy is the gold standard for SRCC as it is for other types of gastric cancers, SRCC is particularly difficult to diagnose because it has high false-negative rates of endoscopic biopsy results.…”

“…A case series of patients with skeletal muscle metastasis from diverse primaries reported a mean survival of 9 months from the diagnosis of muscle metastasis. 8 There are several reports and reviews highlighting the development of SRCC in the gastrointestinal system, but there are very few reported cases of this malignancy presenting as metastasis to the peripheral musculature. 8 The incidence of skeletal metastasis is unknown, but approximately 0.16%–0.03% has been reported in clinical practice, and 0.8% in an autopsy study.…”

“… 8 There are several reports and reviews highlighting the development of SRCC in the gastrointestinal system, but there are very few reported cases of this malignancy presenting as metastasis to the peripheral musculature. 8 The incidence of skeletal metastasis is unknown, but approximately 0.16%–0.03% has been reported in clinical practice, and 0.8% in an autopsy study. 9 Although the mechanism of SRCC metastasis to skeletal and cardiac muscle is unclear, it is thought to occur through hematogenous spread of tumor, particularly because these tissues are well-vascularized.…”

“… 9 Although the mechanism of SRCC metastasis to skeletal and cardiac muscle is unclear, it is thought to occur through hematogenous spread of tumor, particularly because these tissues are well-vascularized. 8 Of note, the paravertebral muscles are the most frequently involved site of muscle metastases from a gastric primary. 10 …”

Anti‑metastatic effects of Aidi on human esophageal squamous cell carcinoma by inhibiting epithelial‑mesenchymal transition and angiogenesis

“…Tumor metastasis is the main cause of mortality associated with esophageal squamous cell carcinoma ( 6 ). Due to the lack of serous layer in the esophageal wall, direct infiltration and metastasis can occur in the early stage of esophageal cancer ( 7 ). It has been reported that 56% of patients have suffered from blood vessel metastasis and 32% of patients have suffered from lymph metastasis during tumor invasion of the submucosal tissue ( 8 ).…”