Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 24, 2020; 11(2): 83-90
Published online Feb 24, 2020. doi: 10.5306/wjco.v11.i2.83
Pancreatic adenocarcinoma with early esophageal metastasis: A case report and review of literature
Ethan Alexander Burns, Saro Kasparian, Usman Khan, Maen Abdelrahim
Ethan Alexander Burns, Saro Kasparian, Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, United States
Usman Khan, Maen Abdelrahim, Department of Oncology, Houston Methodist Cancer Center, Houston, TX 77030, United States
Author contributions: Burns EA and Kasparian S reviewed the literature; Burns EA, Kasparian S, Khan U and Abdelrahim M contributed to the conception and design of the manuscript and manuscript drafting, and revision of the manuscript for intellectual content; Khan U imaged analysis and interpretation; Abdelrahim M was the patient’s oncologist and was responsible for the critical revision of the manuscript for intellectual content. All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the deceased patient’s next of kin for publication of this report and any accompanying radiographic/histologic images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist, and declare that the CARE Checklist–2016: Information for writing a case report” have been adopted.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Maen Abdelrahim, BPharm, MD, PhD, Attending Doctor, Department of Oncology, Houston Methodist Cancer Center, 6445 Fannin, OPC-24, Houston, TX 77030. mabdelrahim@houstonmethodist.org
Received: July 6, 2019
Peer-review started: July 7, 2019
First decision: August 20, 2019
Revised: November 23, 2019
Accepted: December 19, 2019
Article in press: December 19, 2019
Published online: February 24, 2020
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

Esophageal metastasis diagnosed before primary pancreatic adenocarcinoma is rare. This case highlights the profound metastatic potential of pancreatic adenocarcinoma.

Keywords: Pancreatic body neoplasm, Adenocarcinoma, Esophagus, Metastasis, Dysphagia, Earache, Carcinogenesis, Case report

Core tip: Pancreatic adenocarcinoma is an aggressive malignancy with a high mortality rate and propensity to metastasize. We present a rare case of metastatic pancreatic adenocarcinoma to the esophagus and cervical lymph nodes presenting as dysphagia and an earache months before the primary pancreatic mass was detected on radiographic imaging. This case highlights the highly aggressive nature of pancreatic adenocarcinomas and the metastatic potential early in the disease course. In the setting of metastatic adenocarcinoma of unknown primary, clinicians should consider the possibility of a pancreatic origin.