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Esophageal squamous cell carcinoma presenting with extensive skin lesions: a case report.

Iwanski GB, Block A, Keller G, Muench J, Claus S, Fiedler W, Bokemeyer C - J Med Case Rep (2008)

Bottom Line: The incidence of esophageal cancer varies greatly among regions of the world and occurs at a high frequency in Asia and South America.Cutaneous manifestations of esophageal neoplasia are very rare and are mainly described for esophageal adenocarcinoma (EADC).Early biopsies of suspicious skin lesions are important and should be performed in patients with unclear symptoms such as weight loss or dysphagia and especially in patients with a history of cancer, since they can reveal the existence of a distant malignant disease leading to diagnosis and prompt therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Oncology and Hematology, University Hospital Hamburg, Eppendorf, Martinistrasse, Hamburg, Germany. g.iwanski@uke.uni-hamburg.de

ABSTRACT

Introduction: Esophageal squamous cell carcinoma (ESCC) is the most common histological subtype of cancer in the upper and middle esophagus and is characterized by a high rate of mortality. The incidence of esophageal cancer varies greatly among regions of the world and occurs at a high frequency in Asia and South America.

Case presentation: In our department, a 51-year-old man was diagnosed with ESCC after presenting with extensive disseminated skin nodules. Biopsy of the nodules showed metastatic ESCC. Cutaneous manifestations of esophageal neoplasia are very rare and are mainly described for esophageal adenocarcinoma (EADC). Here we report a very uncommon case of extensive skin metastases of ESCC.

Conclusion: Early biopsies of suspicious skin lesions are important and should be performed in patients with unclear symptoms such as weight loss or dysphagia and especially in patients with a history of cancer, since they can reveal the existence of a distant malignant disease leading to diagnosis and prompt therapy.

No MeSH data available.


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Thoraco-abdominal CT scan showing two representative cutaneous metastases (arrows).
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Figure 3: Thoraco-abdominal CT scan showing two representative cutaneous metastases (arrows).

Mentions: A 51-year-old man was admitted to our department with a four-week history of dysphagia, weight loss and nausea. He had a medical history of multiple sclerosis since April 2004 and a smoking history of 30 pack-years. The patient underwent esophagogastroduodenoscopy resulting in the diagnosis of esophageal carcinoma located in the mid-thoracic part of the esophagus. Histology of an endosonography-guided biopsy showed an intermediate grade ESCC according to the criteria of the American Joint Committee of Cancer (AJCC). Moreover, the patient presented with approximately 20 diffuse, painless and solid skin nodules that were about 1–3 cm in diameter, found all over his body surface including the scalp, upper extremities, axillae, back, chest and abdominal wall. According to the patient they had been growing rapidly over the previous four weeks, and he had noticed the first skin lesion more than two months earlier. Excisional biopsy of one representative prominent cutaneous formation on the abdominal wall was performed. On macroscopic inspection, the lesion was superficially ulcerated and measured 2 cm × 3 cm (Figure 1). Histopathology revealed nodulous skin infiltration of intermediate grade ESCC (Figure 2). Interestingly, staging by thoracoabdominal computed tomography (CT) scan showed some of these skin lesions (Figure 3). Extensive mediastinal lymph nodes and multiple osteolytic lesions of the spine were also detected without signs of any other tumor manifestation (T1-2, N1, M1, G2; ESCC state IV). The patient subsequently received palliative chemotherapy with cisplatin (80 mg/sqm) and 5-fluoruracil (1,000 mg/sqm) given over four days every three weeks. After three cycles of chemotherapy, the cutaneous metastases became smaller, but some appeared in new areas.


Esophageal squamous cell carcinoma presenting with extensive skin lesions: a case report.

Iwanski GB, Block A, Keller G, Muench J, Claus S, Fiedler W, Bokemeyer C - J Med Case Rep (2008)

Thoraco-abdominal CT scan showing two representative cutaneous metastases (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2365965&req=5

Figure 3: Thoraco-abdominal CT scan showing two representative cutaneous metastases (arrows).
Mentions: A 51-year-old man was admitted to our department with a four-week history of dysphagia, weight loss and nausea. He had a medical history of multiple sclerosis since April 2004 and a smoking history of 30 pack-years. The patient underwent esophagogastroduodenoscopy resulting in the diagnosis of esophageal carcinoma located in the mid-thoracic part of the esophagus. Histology of an endosonography-guided biopsy showed an intermediate grade ESCC according to the criteria of the American Joint Committee of Cancer (AJCC). Moreover, the patient presented with approximately 20 diffuse, painless and solid skin nodules that were about 1–3 cm in diameter, found all over his body surface including the scalp, upper extremities, axillae, back, chest and abdominal wall. According to the patient they had been growing rapidly over the previous four weeks, and he had noticed the first skin lesion more than two months earlier. Excisional biopsy of one representative prominent cutaneous formation on the abdominal wall was performed. On macroscopic inspection, the lesion was superficially ulcerated and measured 2 cm × 3 cm (Figure 1). Histopathology revealed nodulous skin infiltration of intermediate grade ESCC (Figure 2). Interestingly, staging by thoracoabdominal computed tomography (CT) scan showed some of these skin lesions (Figure 3). Extensive mediastinal lymph nodes and multiple osteolytic lesions of the spine were also detected without signs of any other tumor manifestation (T1-2, N1, M1, G2; ESCC state IV). The patient subsequently received palliative chemotherapy with cisplatin (80 mg/sqm) and 5-fluoruracil (1,000 mg/sqm) given over four days every three weeks. After three cycles of chemotherapy, the cutaneous metastases became smaller, but some appeared in new areas.

Bottom Line: The incidence of esophageal cancer varies greatly among regions of the world and occurs at a high frequency in Asia and South America.Cutaneous manifestations of esophageal neoplasia are very rare and are mainly described for esophageal adenocarcinoma (EADC).Early biopsies of suspicious skin lesions are important and should be performed in patients with unclear symptoms such as weight loss or dysphagia and especially in patients with a history of cancer, since they can reveal the existence of a distant malignant disease leading to diagnosis and prompt therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Oncology and Hematology, University Hospital Hamburg, Eppendorf, Martinistrasse, Hamburg, Germany. g.iwanski@uke.uni-hamburg.de

ABSTRACT

Introduction: Esophageal squamous cell carcinoma (ESCC) is the most common histological subtype of cancer in the upper and middle esophagus and is characterized by a high rate of mortality. The incidence of esophageal cancer varies greatly among regions of the world and occurs at a high frequency in Asia and South America.

Case presentation: In our department, a 51-year-old man was diagnosed with ESCC after presenting with extensive disseminated skin nodules. Biopsy of the nodules showed metastatic ESCC. Cutaneous manifestations of esophageal neoplasia are very rare and are mainly described for esophageal adenocarcinoma (EADC). Here we report a very uncommon case of extensive skin metastases of ESCC.

Conclusion: Early biopsies of suspicious skin lesions are important and should be performed in patients with unclear symptoms such as weight loss or dysphagia and especially in patients with a history of cancer, since they can reveal the existence of a distant malignant disease leading to diagnosis and prompt therapy.

No MeSH data available.


Related in: MedlinePlus