Ali Rebaz, Hawramy Omar H Ghalib, Kakamad Fahmi H, Hamasaeed Dlshad, Tahir Soran H, Ismaeil Deari A, Awalmohammed Bahra A, Ali Hemn H Kaka, Mohammed Bruj Jamil, Abdullah Hiwa O, Abdalla Berun A
Hiwa Cancer Hospital Centre, Sulaimani Directorate of Health, Sulaimani, Kurdistan 46000, Iraq.
Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.
Med Int (Lond). 2023 Jun 14;3(3):31. doi: 10.3892/mi.2023.91. eCollection 2023 May-Jun.
Subcutaneous metastasis from esophageal cancer (EC), particularly to the chest wall, is a very rare phenomenon. The present study describes a case of gastroesophageal adenocarcinoma that metastasized to the chest wall, invading the fourth anterior rib. A 70-year-old female presented with acute chest pain 4 months after undergoing Ivor-Lewis esophagectomy for gastroesophageal adenocarcinoma. A chest ultrasound revealed a solid hypoechoic mass on the right side of the chest. A contrast-enhanced computed tomography scan of the chest revealed a destructive mass on the right anterior fourth rib (7.5x5 cm). Fine needle aspiration revealed a metastatic moderately differentiated adenocarcinoma to the chest wall. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography revealed a large FDG avid deposit on the right side of the chest wall. Under general anesthesia, a right-side anterior chest incision was made and the second, third and fourth ribs were resected with overlying soft tissues, including the pectoralis muscle and overlying skin. The histopathological examination confirmed a metastasized gastroesophageal adenocarcinoma to the chest wall. There are two common assumptions regarding chest wall metastasis from EC. The first one states that this metastasis can occur due to the implantation of the carcinoma during tumor resection. The latter supports the notion of tumor cell dissemination along the esophageal lymphatic and hematogenous systems. Chest wall metastasis from EC invading ribs is an extremely rare incident. However, its likelihood of occurrence should not be neglected following primary cancer treatment.
食管癌（EC）的皮下转移，尤其是转移至胸壁，是一种非常罕见的现象。本研究描述了一例胃食管腺癌转移至胸壁并侵犯第四前肋的病例。一名70岁女性在接受Ivor-Lewis食管切除术治疗胃食管腺癌4个月后出现急性胸痛。胸部超声显示右侧胸部有一个实性低回声肿块。胸部增强计算机断层扫描显示右侧第四前肋有一个破坏性肿块（7.5×5厘米）。细针穿刺显示为胸壁转移性中分化腺癌。氟脱氧葡萄糖（FDG）-正电子发射断层扫描/计算机断层扫描显示胸壁右侧有一个大量摄取FDG的沉积物。在全身麻醉下，做右侧前胸切口，切除第二、第三和第四肋骨及其上方的软组织，包括胸大肌和覆盖的皮肤。组织病理学检查证实为胃食管腺癌转移至胸壁。关于食管癌胸壁转移有两个常见的假设。第一个假设是这种转移可能是由于肿瘤切除过程中癌细胞的种植。后者支持肿瘤细胞沿食管淋巴和血行系统播散的观点。食管癌侵犯肋骨导致胸壁转移是极其罕见的事件。然而，在原发性癌症治疗后，其发生的可能性不应被忽视。
