Chen Yen-Hao, Huang Cheng-Hua
Yen-Hao Chen, Cheng-Hua Huang, Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
World J Gastroenterol. 2014 Sep 21;20(35):12691-5. doi: 10.3748/wjg.v20.i35.12691.
Patients with esophageal squamous cell carcinoma generally present at an advanced stage at the time of diagnosis. The most common sites of visceral metastasis are the lung, liver and bone, but brain and bone marrow involvement is exceedingly rare. Herein, we report a 62-year-old man with a 4-wk history of progressive low back pain with radiation to bilateral lower legs, dysphagia and body weight loss. Esophageal squamous cell carcinoma with regional lymph node, liver and bone metastases was diagnosed. He underwent concurrent chemoradiotherapy and got a partial response. Four months later, he complained of headache, diplopia and severe hearing impairment in the left ear. There was no evidence for bacterial, fungal, tuberculous infection or neoplastic infiltration. Magnetic resonance imaging of the brain demonstrated thickening and enhancement of bilateral pachymeninges and multiple enhancing masses in bilateral skull. Dural metastasis was diagnosed and he received whole brain irradiation. In addition, laboratory examination revealed severe thrombocytopenia and leucopenia, and bone marrow study confirmed the diagnosis of metastatic squamous cell carcinoma. This is the first described case of esophageal squamous cell carcinoma with dural and bone marrow metastases. We also discuss the pathogenesis of unusual metastatic diseases and differential diagnosis of pachymeningeal thickening.
食管鳞状细胞癌患者在确诊时通常已处于晚期。内脏转移最常见的部位是肺、肝和骨，但脑和骨髓受累极为罕见。在此，我们报告一名62岁男性，有4周进行性下背痛病史，疼痛放射至双侧小腿，伴有吞咽困难和体重减轻。诊断为食管鳞状细胞癌伴区域淋巴结、肝和骨转移。他接受了同步放化疗并获得部分缓解。四个月后，他出现头痛、复视和左耳严重听力障碍。没有细菌、真菌、结核感染或肿瘤浸润的证据。脑部磁共振成像显示双侧硬脑膜增厚并强化，双侧颅骨有多个强化肿块。诊断为硬脑膜转移，他接受了全脑照射。此外，实验室检查显示严重血小板减少和白细胞减少，骨髓检查确诊为转移性鳞状细胞癌。这是首例报道的食管鳞状细胞癌伴硬脑膜和骨髓转移的病例。我们还讨论了不寻常转移性疾病的发病机制以及硬脑膜增厚的鉴别诊断。
