Burns Ethan Alexander, Kasparian Saro, Khan Usman, Abdelrahim Maen
Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, United States.
Department of Oncology, Houston Methodist Cancer Center, Houston, TX 77030, United States.
World J Clin Oncol. 2020 Feb 24;11(2):83-90. doi: 10.5306/wjco.v11.i2.83.
Pancreatic adenocarcinoma is an aggressive malignancy with a high propensity to metastasize. Esophageal metastasis manifesting as dysphagia is rarely reported in the literature and has not to our knowledge been reported prior to the appearance of the primary disease.
A patient presented with progressive dysphagia to solids and a persistent earache. Computed tomography of the neck and chest revealed a 3.0 cm × 1.8 cm heterogeneous mass originating from the upper third of the esophagus, necrotic cervical and supraclavicular lymphadenopathy, and bilateral pulmonary nodules. She underwent a core needle biopsy of a right cervical node, which suggested a well-differentiated adenocarcinoma of unknown primary. She had an upper endoscopy with biopsy of the esophageal mass suggestive of a well-differentiated adenocarcinoma. Positron emission tomography imaging revealed increased uptake in the esophageal mass, cervical, and mediastinal lymph nodes. She was started on folinic acid, fluorouracil, and oxaliplatin. Prior to initiation of cycle 8, the patient was found to have a pancreatic body mass that was not present on prior radiographic imaging, confirmed by endoscopic ultrasonography and biopsy to be pancreatic adenocarcinoma. CA19-9 was > 10000 U/mL, suggesting a primary pancreaticobiliary origin.
Esophageal metastasis diagnosed before primary pancreatic adenocarcinoma is rare. This case highlights the profound metastatic potential of pancreatic adenocarcinoma.
胰腺腺癌是一种侵袭性恶性肿瘤，具有较高的转移倾向。文献中很少报道以吞咽困难为表现的食管转移，据我们所知，在原发性疾病出现之前尚未有过相关报道。
一名患者出现进行性固体食物吞咽困难和持续性耳痛。颈部和胸部计算机断层扫描显示，一个3.0 cm×1.8 cm的不均匀肿块起源于食管上三分之一处，伴有坏死的颈部和锁骨上淋巴结病以及双侧肺结节。她接受了右侧颈部淋巴结的粗针活检，提示为原发灶不明的高分化腺癌。她接受了上消化道内镜检查，并对食管肿块进行活检，提示为高分化腺癌。正电子发射断层扫描成像显示食管肿块、颈部和纵隔淋巴结摄取增加。她开始接受亚叶酸、氟尿嘧啶和奥沙利铂治疗。在第8周期开始前，发现患者胰腺体部有一个之前影像学检查未出现的肿块，经内镜超声检查和活检证实为胰腺腺癌。CA19-9大于10000 U/mL，提示原发性胰胆管起源。
在原发性胰腺腺癌之前诊断出食管转移很少见。该病例突出了胰腺腺癌强大的转移潜能。
