Soft Tissue Metastases as the First Clinical Manifestation of Squamous Cell Carcinoma of the Esophagus: Case Report.

Soft tissue metastases are an uncommon presenting feature for primary solid tumours. This case highlights a rare presentation in which a soft tissue mass is the first clinical manifestation of a widespread disseminated malignancy of the esophagus. A 73-year-old woman presented with a soft swelling in the left upper quadrant of the abdomen arising from the anterior abdominal wall, suspicious of liposarcoma. Core biopsies revealed squamous carcinoma. Immunohistochemistry suggested the most likely diagnosis was that of metastatic carcinoma with a number of potential primary sites. Computed tomography scanning showed widespread metastatic disease, including lung, liver, kidney, omentum, subcutaneous and intramuscular lesions. The distal esophagus was noted to be circumferentially thickened. Finally, upper gastrointestinal endoscopy revealed carcinoma of the esophagus. The patient remains well awaiting esophageal stenting and palliative chemotherapy. In conclusion, it is important to be able to distinguish the origin of a soft-tissue swelling as the management will depend significantly on the histological type. Soft-tissue metastases are rarely encountered as a presenting sign of an occult cancer. Primary cancers that most commonly metastasise to soft tissues include those arising within the lung, colon and kidney. The most frequent histological diagnosis is adenocarcinoma. This case demonstrates the utility of biopsy in the investigation of soft tissue masses when the clinical presentation is unusual.