Challenges in the diagnosis of esophageal cancer with intramural gastric metastasis: Two case reports

BACKGROUND Esophageal squamous cell carcinoma (ESCC) is a prevalent gastrointestinal malignancy associated with significant morbidity and mortality rates. Tumor metastasis leads to a poor prognosis for patients. Intramural gastric metastasis (IGM), is an uncommon pathway of ESCC metastasis, and is more likely to occur when in situ tumor cells show deep infiltration. In this study, we describe the diagnosis and management of two rare cases of T1-stage ESCC with IGM in clinical practice. CASE SUMMARY Case 1: In this patient, the submucosal tumor-like lesion was initially thought to be a gastrointestinal stromal tumor. T1-stage ESCC was then diagnosed by gastro-endoscopy during subsequent evaluation. The lesion was finally confirmed to be submucosal metastasis of ESCC following pathological analysis. The patient has been receiving treatment for over seven months, with an encouraging outcome. Case 2: In this patient, the initial diagnostic phase showed esophageal and gastric lesions which were classified as two distinct conditions: Early-stage ESCC and a gastrointestinal stromal tumor, respectively. However, postoperative pathology revealed ESCC with IGM. The patient received adjuvant chemotherapy following surgical intervention. Regrettably, the patient was lost to follow-up shortly after surgery. CONCLUSION The occurrence of IGM in T1-stage ESCC is rare. IGM should be taken into consideration when diagnosing submucosal tumor-like lesions to prevent misdiagnosis and missed diagnosis.