Afaq Z Khan, Dr, Iqbal Khan, Dr, Asad Z Khan, Shahbano Jamali, Dr
Hays Medical Center
The link between esophageal carcinoma and metastasis to skeletal muscles is extremely rare. Only eight cases have been reported in medical literature so far. We report a 79 year old lady presenting with worsening dysphagia. EGD revealed a large mass extending from mid to distal esophagus partially occluding the lumen. Histopathology came back consistent with moderately differentiated adenocarcinoma of the esophagus. Staging CT scans showed a large hiatal hernia with thickening of distal esophagus. A 1.6 cm lesion in the liver and 1.8 cm enlarged perigastric lymph node were seen as well. PET scan showed multiple soft tissue abnormalities in left shoulder, erector spinae and pelvic musculature. Core needle biopsy of the gluteal musculature showed metastatic adenocarcinoma of gastroesophageal origin. Metastasis to skeletal muscles represents less than 1% of all hematogenous spread from solid tumors. Inspite of skeletal muscles being well vascularised, the rarity of metastasis may be secondary to proteases and other inhibitors blocking tumor invasion. Treatment options include observation, excision, radiotherapy and chemotherapy. This case report highlights multiple asymptomatic muscle metastases. It also elucidates the advantage of PET scan over a CT scan in identifying metastatic lesions.
Session: Poster Presentation
Program Number: P194