A rare case of esophageal metastasis from signet-ring cell carcinoma of the cecum

Yoichi Tanaka; Osamu Chino; Hiroshi Kajiwara; Tomoko Hanashi; Tomoki Nakamura; Hiroyasu Makuuchi

doi:10.1186/s40792-023-01768-8

A rare case of esophageal metastasis from signet-ring cell carcinoma of the cecum

Surg Case Rep. 2023 Oct 24;9(1):186. doi: 10.1186/s40792-023-01768-8.

Authors

Yoichi Tanaka¹, Osamu Chino², Hiroshi Kajiwara³, Tomoko Hanashi², Tomoki Nakamura², Hiroyasu Makuuchi⁴

Affiliations

¹ Department of Surgery, Tokai University Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan. yoichit@is.icc.u-tokai.ac.jp.
² Department of Surgery, Tokai University Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan.
³ Department of Pathology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
⁴ Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.

Abstract

Background: Metastatic esophageal cancer is rare. Its common primary lesions include lung cancer and breast cancer. Metastatic esophageal cancer originating from colorectal cancer is rarer.

Case presentation: A 79-year-old woman visited our hospital because of lower abdominal discomfort. She was endoscopically diagnosed with type 0-IIa + IIc cancer of the cecum, and biopsy of the lesion showed signet-ring cell carcinoma. With a preoperative clinical staging of cStage I (cT2, cN0, cM0), the patient underwent laparoscopic ileocecal resection with D3 lymphadenectomy. Histopathological examination of the resected specimens revealed signet-ring cell carcinoma [type 4, pT4a, pN3 (No. 203), M0, pRM1, stage IIIc, R1]. Despite radial margin positivity, the patient refused resection of the residual tumor and received oral tegafur and uracil. KRAS mutation test showed KRAS wild-type colon cancer, but she refused anti-epidermal growth factor receptor therapy. One year after surgery, her blood carcinoembryonic antigen concentration elevated. Colonoscopy showed anastomotic recurrence and biopsy of the lesion showed signet-ring cell carcinoma. Upper gastrointestinal endoscopy showed multiple longitudinal submucosal tumors with erosions on their surfaces in the esophagus. Tumor biopsy revealed signet-ring cell carcinoma. Immunohistochemistry showed that the histological type of the esophageal tumors was the same as that of the primary colon cancer. Based on these findings, the esophageal tumors were diagnosed with metastasis from signet-ring cell carcinoma of the cecum. The oral chemotherapy was replaced with FOLFOX plus bevacizumab. However, the patient's condition required treatment discontinuation, and she died of cancer progression 1 year and 5 months after surgery.

Conclusions: To our knowledge, this is the first case report on metastatic esophageal cancer from signet-ring cell carcinoma of the cecum. Esophagoscopy showed multiple longitudinal submucosal tumors, which is similar to an endoscopic finding of intramural metastasis from primary esophageal cancer. We consider that the multiple longitudinal submucosal tumors are a notable feature of our case. When metastatic esophageal cancer is suspected, clinicians, endoscopists, and pathologists should consider signet-ring cell carcinoma of the colon as one of potential primary lesions. This consideration could lead the specialists to appropriate examinations and treatments, thereby improving clinical outcomes in patients with the metastasis.

Keywords: Colorectal cancer; Immunohistochemistry; Intramural metastasis; Metastatic esophageal cancer; Signet-ring cell carcinoma; Submucosal tumor.