Puri Sonam, Holle Lisa M, Forouhar Faripour A, Clement Jessica M
1 Department of Hematology and Oncology, H Lee Moffitt Cancer Center/University of South Florida, Tampa, FL, USA.
2 Department of Pharmacy Practice, UConn School of Pharmacy, Storrs, CT, USA.
J Oncol Pharm Pract. 2019 Mar;25(2):492-496. doi: 10.1177/1078155217736920. Epub 2017 Oct 27.
Esophageal cancer is the 11th most common cause of cancer mortality in the United States. It is aggressive in nature and has an ability to spread rapidly through direct extension, lymphatic spread, or hematogenously. With an estimated incidence of 1%, cutaneous metastases from esophageal cancer are extremely rare.
In this case study and review, we describe a case of recurrent esophageal basaloid squamous cell carcinoma presenting as multiple, rapidly progressing and tender subcutaneous nodules. A 69-year-old male with history of basaloid squamous cell carcinoma of the esophagus treated with concurrent chemoradiation, presented to his oncologist with complaints of a large, painful nodule at the nape of his neck approximately two years after completing treatment. On further examination, he was noted to have multiple, well circumscribed, solid, tender nodules on his abdominal wall along with a painful nodule on the pulp of his index finger. Histopathology from all sites revealed skin infiltration by high-grade invasive basaloid subtype of squamous cell carcinoma, similar to patient's prior known and treated primary esophageal cancer. Further imaging work up showed extensive metastatic disease involving lung, liver, and brain.
Esophageal squamous cell carcinoma rarely metastasize to the skin. Subcutaneous nodules can be the first presentation of recurrent disease. The lesions are commonly confused with skin infections and treated inappropriately with antibiotics, leading to delay in diagnosis of recurrent disease. Early biopsy of suspicious lesions should be performed, especially in patients with history of cancer, such that prompt diagnosis and treatment can occur to maximize patient outcomes.
食管癌是美国癌症死亡的第11大常见原因。其本质上具有侵袭性，能够通过直接蔓延、淋巴转移或血行转移迅速扩散。食管癌皮肤转移的估计发生率为1%，极为罕见。
在本病例研究及综述中，我们描述了一例复发性食管基底样鳞状细胞癌，表现为多个迅速进展且压痛的皮下结节。一名69岁男性，有食管基底样鳞状细胞癌病史，接受了同步放化疗，在完成治疗约两年后，因颈部后方出现一个大的疼痛性结节就诊于肿瘤学家。进一步检查发现，他的腹壁有多个边界清晰、实性、压痛的结节，以及食指指腹有一个疼痛性结节。所有部位的组织病理学检查均显示为高级别浸润性基底样亚型鳞状细胞癌浸润皮肤，与患者先前已知并接受治疗的原发性食管癌相似。进一步的影像学检查显示广泛的转移性疾病，累及肺、肝和脑。
食管鳞状细胞癌很少转移至皮肤。皮下结节可能是复发性疾病的首发表现。这些病变常被误诊为皮肤感染并不恰当地使用抗生素治疗，导致复发性疾病的诊断延迟。对于可疑病变应尽早进行活检，尤其是有癌症病史的患者，以便能够及时诊断和治疗，使患者预后最大化。
