Gastroenterology Service, Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA.
J Gastrointestin Liver Dis. 2009 Sep;18(3):371-4.
The association between esophageal adenocarcinoma and distant skeletal muscle metastasis is extremely rare. Only three cases have been previously reported in the literature. All reported involvement of the gastroesophageal junction. We describe a 58 year-old Caucasian man who presented with worsening right hip pain for nine months. Computerized axial tomography (CT) scan demonstrated a 10 cm by 8 cm by 12 cm intra-pelvic mass involving the right iliacus muscle with central destruction of the right mid-ileum. CT-guided biopsy of the right hip mass demonstrated poorly differentiated carcinoma. CT scan of the chest revealed a 5 cm by 4 cm circumferential mass involving the distal esophagus. Endoscopic biopsy showed poorly differentiated adenocarcinoma. Immunohistochemical analysis of each specimen correlated for pancytokeratin. Final diagnosis was primary esophageal adenocarcinoma with distant metastasis to the right ileum and iliacus muscle. We review distinctions between esophageal adenocarcinoma and adenocarcinoma of the gastroesophageal junction. A brief discussion of diagnostic modalities and treatment options are provided.
食管腺癌与远处骨骼肌转移的相关性极为罕见。既往文献仅报道过三例，且均报道累及胃食管结合部。我们描述了一例 58 岁白人男性，因右髋部疼痛加重 9 个月就诊。计算机轴向断层扫描（CT）显示盆腔内有一个 10cm×8cm×12cm 的肿块，累及右侧髂腰肌，伴有右中回肠中央破坏。右髋部肿块的 CT 引导活检显示低分化癌。胸部 CT 显示一个 5cm×4cm 的环形肿块累及远端食管。内镜活检显示低分化腺癌。对每个标本的免疫组化分析均显示细胞角蛋白阳性。最终诊断为原发性食管腺癌，远处转移至右回肠和髂腰肌。我们回顾了食管腺癌和胃食管结合部腺癌之间的区别。并简要讨论了诊断方法和治疗选择。
