Esophageal Adenocarcinoma with Extensive Metastasis to Unexpected Sites: A Case Report

Background: Esophageal cancer (EC) with unexpected metastasis (UM) to unusual sites have been increasingly reported. EC with metastasis in general has a very high mortality and morbidity rate, and those with UM to unusual sites present another specific field that needs to be further studied in order to understand and manage the presentation. An extensive systematic review was recently completed regarding this field which identified characteristics and findings concerning patients with EC with UM sites. Case Presentation: We report a 61 year old Hispanic male who had an EC, adenocarcinoma subtype, with UM to an extensive number of sites such as the soft tissue of the cheek, subcutaneous forehead and scalp with penetration of the calvarium, occipital bone, base of tongue, neck muscles, paraspinal and iliopsoas musculature and, more typically, to an adrenal gland followed by a questionable new-onset finding of subcutaneous shoulder and flank nodules not initially identified by imaging. Discussion/Conclusion: The case reports a patient who not only had EC with UM to unusual sites, but also to a considerable number. The patient correlated well in terms of clinical features identified by the systematic review of this particular field, but his case also showed a new finding, another unexpected metastasis site. This case also shows an example of why the type of imaging is important when dealing with UM sites. With this, we hope to further add to the data in this particular field and provide some opinion on this matter.