Esophageal cancer is a highly aggressive malignancy associated with a generally poor clinical prognosis. While distant metastases are common, the metastasis of esophageal squamous cell carcinoma (ESCC) to the pancreas and stomach is extremely rare. We report the case of a 62-year-old male with a history of ESCC who presented with an incidentally discovered pancreatic mass on imaging 37 months after the completion of radiotherapy. The patient subsequently underwent radical surgical resection. Postoperative histopathological and immunohistochemical analyses confirmed the presence of pancreatic and gastric metastases originating from the primary ESCC. For subsequent disease management, the patient received a systemic regimen comprising immune checkpoint inhibitors combined with platinum-based chemotherapy. This case underscores the importance of considering rare metastases in the differential diagnosis of new pancreatic lesions in patients with a history of ESCC, even following a prolonged disease-free interval. Furthermore, it suggests that aggressive surgical resection combined with postoperative immunochemotherapy may represent a viable multidisciplinary therapeutic strategy for managing such atypical metastatic presentations.
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