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Table of Contents
CASE REPORT
Year : 2013  |  Volume : 1  |  Issue : 2  |  Page : 116-117

Unusual bony metastasis in a case of oesophageal carcinoma<


1 Resident, Department of Otorhinolaryngology and Head and Neck Surgery, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
2 Assistant Professor, Department of Otorhinolaryngology and Head and Neck Surgery, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
3 Associate Professor, Department of Otorhinolaryngology and Head and Neck Surgery, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
4 >Professor & Head, Department of Otorhinolaryngology and Head and Neck Surgery, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India

Date of Web Publication21-Aug-2018

Correspondence Address:
J A Shah
Resident, Department of Otorhinolaryngology and Head and Neck Surgery, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.239494

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  Abstract 


Cancer oesophagus is the ninth most common cancer and is the sixth most common cause of cancer related deaths in the world. It usually presents in advanced stage with loco-regional node and visceral involvement. Bone metastasis is uncommon. Here we are reporting a case of a 55-year-old male, with progressive dysphagia to solids and semisolids for 1 year. Rigid endoscope guided biopsy confirmed that histology was well differentiated squamous cell carcinoma. Computed Tomography (CT) scan of the neck and thorax revealed oesophageal malignancy with enlarged neck lymph nodes on left side and metastasis in left greater wing of sphenoid, part of temporal bone and lateral wall of the orbit and abutting the left lateral rectus muscle. Literature search revealed that bony metastases are very infrequent and small bones are usually spared. This case is noticeable for rarity in terms of metastatising to unusual sites.

Keywords: Cancer oesophagus, Bone metastasis, Greater wing of sphenoid, Orbit


How to cite this article:
Shah J A, Chauhan N V, Singhania A A, George A. Unusual bony metastasis in a case of oesophageal carcinoma<. J Integr Health Sci 2013;1:116-7

How to cite this URL:
Shah J A, Chauhan N V, Singhania A A, George A. Unusual bony metastasis in a case of oesophageal carcinoma<. J Integr Health Sci [serial online] 2013 [cited 2022 Aug 12];1:116-7. Available from: https://www.jihs.in/text.asp?2013/1/2/116/239494




  Introduction Top


The poor prognosis of oesophageal cancer is proof of its ability to spread. On the whole it is the sixth commonest cause of cancer related deaths in the world.[1] It usually presents in advanced stage with loco-regional node and visceral involvement. Bone metastasis is uncommon and usually denotes terminal stage as a part of multiple systemic involvements.2 Here we report a rare case of carcinoma oesophagus with bony metastasis as it is evidenced by very small number of clinical series and published case reports.


  Case Report Top


A 50-year-old woman came to the department who A 55-year-old man, presented with progressive dysphagia to solids and semisolids for 1 year and hoarseness of voice for 3 months. There were no other complaints related to either gastrointestinal or any other system. Haematological investigations were within normal limits. Rigid oesophagoscopy revealed an ulcerative lesion at 23 cm from upper central incisor teeth in posterior and left lateral wall. Pathologic study of an endoscope guided biopsy confirmed that histology was well differentiated squamous cell carcinoma keratinizing type. Computed Tomography (CT) of the neck and thorax was performed with intravenous contrast. CT scan revealed oesophageal malignancy with enlarged neck nodes on left side and erosive lesions in left greater wing of sphenoid, part of temporal bone and lateral wall of the orbit. Post contrast study showed enhancement of the lesions with soft tissue extension suggestive of metastasis. There is also an involvement of left side of lateral rectus muscle indicating intra-orbital extension. However there was no evidence of metastasis in eye or orbit on ophthalmology evaluation. Patient was then referred for chemotherapy and radiotherapy.


  Discussion Top


Literature states that among the distant metastases from carcinoma oesophagus, 45% are seen in abdominal lymph nodes followed by liver (35%), lung (20%), cervical / supra-clavicular lymph nodes (18%), bone (9%), adrenal (5%), peritoneum (2%), brain (2%) and stomach, pancreas, pleura, skin / body wall, pericardium and spleen (each 1%). More than 50% of the oesophageal cancers are unresectable or have radiographically visible distant metastases at the time of diagnosis. In a large series of patients with oesophageal cancers 18% were detected to have Ml disease, of which majority were diagnosed prior to surgery by CT scan of the chest and abdomen. Reported sensitivity of CT scanning was 70%.[3]
Figure 1: Metastatic lesion of left greater wing of sphenoid, temporal bone and lateral wall of orbit and abutting left lateral rectus muscle (Solid arrow)

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Metastatic bone disease occurs when cancer spreads from a primary organ site to bone. In females approximately 80% of cancers that spread to bone arise in breast and lungs .[4],[5],[6],[ 7] In males, cancers of the prostate and lungs make up 80% of the carcinomas that metastasize to bone.[9] Small bones are relatively spared from metastasis. Lesser blood supply or ‘soil and seed’ hypothesis is thought to be the reason for this rare incidence. Five to eight per cent of oesophageal cancer patients present with bone metastasis and long bones are commonest site. (2’ In systemic review of 1909 carcinoma oesophagus patients, only 5.2 percent had metastasis to bones and only one patient presented with small bone metastasis that is metatarsal.[10] Oesophageal metastases have been reported in orbit.[11] Extra ocular muscle infiltration due to metastases from carcinoma of gastroesophageal junction has been described in literature. In our case also metastasis occurred to unusual sites like greater wing of sphenoid, temporal bone and orbital wall.


  Conclusion Top


Sometimes, carcinoma of the oesophagus may present with metastasis to rare sites like in the patient in this case report. Hence a wide survey should be done identifying such metastasis in patients of carcinoma oesophagus at the time of diagnosis.



 
  References Top

1.
Enzinger PC, Mayer RJ. Medical Progress: Oesophageal cancer. N Eng J Med 2003; 349: 2241-52.  Back to cited text no. 1
    
2.
A Mohanty, D Dutta, S Das, DR Samanta, S Senapati. Carcinoma oesophagus with isolated metatarsal metastasis. Indian Journal of Cancer. 2011;48(1):112-3.  Back to cited text no. 2
    
3.
Leslie E Quint, Lisa M. Hepburn, Isaac R. Francis, Richard I. Whyte, Mark B. Orringer. Incidence and distribution of distant metastases from newly diagnosed oesophageal carcinoma. Cancer 1995;76:1120- 5.  Back to cited text no. 3
    
4.
Keene JS, Sellinger DS, McBeath AA, et al. Metastatic breast cancer in the femur. A search for the lesion at risk of fracture. Clin Orthop Relat Res. Feb 1986;203:282-8.  Back to cited text no. 4
    
5.
Quattrocchi CC, Piciucchi S, Sammarra M, et al. Bone metastases in breast cancer: higher prevalence of osteosclerotic lesions. Radiol Med (Torino). Oct 2007;112(7):1049-59.  Back to cited text no. 5
    
6.
Alarmo EL, Kallioniemi A. Bone morphogenetic proteins in breast cancer - dual role in tumour genesis? Endocr Relat Cancer.17:123-39.  Back to cited text no. 6
    
7.
Doot RK, Muzi M, Peterson LM, Schubert EK, Gralow JR, Specht JM, et al. Kinetic analysis of 18F-fluoride PET images of breast cancer bone metastases. J Nucl Med. Apr 2010;51(4):521-7.  Back to cited text no. 7
    
8.
Hung JJ, Jeng WJ, Hsu WH, Wu KJ, Chou TY, Hsieh CC, et al. Prognostic factors of postrecurrence survival in completely resected stage I non-small cell lung cancer with distant metastasis. Thorax. Mar 2010;65(3):241-5  Back to cited text no. 8
    
9.
Edwards J. Src kinase inhibitors: an emerging therapeutic treatment option for prostate cancer. Expert Opin Investig Drugs 2010;19:605-14.  Back to cited text no. 9
    
10.
Goodner JT, Turnbull A. Bone metastases in cancer of the oesophagus Am J Radiology 1971;2:365-7.  Back to cited text no. 10
    
11.
Collins MJ, Wojno TH, Grossniklaus HE. Metastatic oesophageal carcinoma to the orbit. Am J Ophthalmol 1999;127(2):228-9  Back to cited text no. 11
    


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Abstract
Introduction
Case Report
Discussion
Conclusion
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