Wang HY, Song C, Ma J, Sun HQ, Yuan P, Liu ZX, Dou WJ. Challenges in the diagnosis of esophageal cancer with intramural gastric metastasis: Two case reports. World J Gastrointest Oncol 2025; 17(8): 110206 [DOI: 10.4251/wjgo.v17.i8.110206]
Corresponding Author of This Article
Wei-Jia Dou, Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, No. 1 Xinsi Road, Xi’an 710038, Shaanxi Province, China. weijia_dou@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hao-Ying Wang, Chun Song, Jing Ma, Hai-Qing Sun, Zhen-Xiong Liu, Wei-Jia Dou, Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, Shaanxi Province, China
Peng Yuan, Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, Shaanxi Province, China
Co-first authors: Hao-Ying Wang and Chun Song.
Co-corresponding authors: Zhen-Xiong Liu and Wei-Jia Dou.
Author contributions: Wang HY and Song C authored the article and made equal contributions as co-first authors; Wang HY, Song C, Ma J, and Sun HQ were responsible for managing the patient, conducting the clinical diagnosis and treatment, and gathering data; Yuan P collected and provided the original images; Liu ZX and Dou WJ oversaw the patient’s diagnosis and treatment, composition and submission of the manuscript, and made equal contributions as co-corresponding authors. All authors have read and approved the final manuscript.
Supported by Clinical Projects of Tangdu Hospital, Fourth Military Medical University, No. 2022LC2231 and No. 2023LC2347; and Talent Launch Project of Tangdu Hospital, No. 2022YFJH013.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Jia Dou, Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, No. 1 Xinsi Road, Xi’an 710038, Shaanxi Province, China. weijia_dou@126.com
Received: June 3, 2025 Revised: June 23, 2025 Accepted: July 14, 2025 Published online: August 15, 2025 Processing time: 74 Days and 22.1 Hours
Abstract
BACKGROUND
Esophageal squamous cell carcinoma (ESCC) is a prevalent gastrointestinal malignancy associated with significant morbidity and mortality rates. Tumor metastasis leads to a poor prognosis for patients. Intramural gastric metastasis (IGM), is an uncommon pathway of ESCC metastasis, and is more likely to occur when in situ tumor cells show deep infiltration. In this study, we describe the diagnosis and management of two rare cases of T1-stage ESCC with IGM in clinical practice.
CASE SUMMARY
Case 1: In this patient, the submucosal tumor-like lesion was initially thought to be a gastrointestinal stromal tumor. T1-stage ESCC was then diagnosed by gastro-endoscopy during subsequent evaluation. The lesion was finally confirmed to be submucosal metastasis of ESCC following pathological analysis. The patient has been receiving treatment for over seven months, with an encouraging outcome. Case 2: In this patient, the initial diagnostic phase showed esophageal and gastric lesions which were classified as two distinct conditions: Early-stage ESCC and a gastrointestinal stromal tumor, respectively. However, postoperative pathology revealed ESCC with IGM. The patient received adjuvant chemotherapy following surgical intervention. Regrettably, the patient was lost to follow-up shortly after surgery.
CONCLUSION
The occurrence of IGM in T1-stage ESCC is rare. IGM should be taken into consideration when diagnosing submucosal tumor-like lesions to prevent misdiagnosis and missed diagnosis.
Core Tip: This case report presents the diagnosis and management of two rare cases of T1-stage esophageal squamous cell carcinoma with intramural gastric metastasis, which were initially considered to be gastrointestinal stromal tumors. In clinical practice, it is necessary to pay attention to this uncommon condition in the diagnosis of gastric submucosal tumor-like lesions. We hope that this study will provide guidance for the diagnosis and therapeutic strategies of this disease.
