Abstract Introduction While the metastasis to the liver, lymph nodes, and lungs are common destinations, soft tissue lesions are remarkably rare, representing only 1.9% of cases with the lower extremity being the most encountered site. In this case, we present an unusual case of metastatic esophageal adenocarcinoma (EAC) initially diagnosed via a biopsy of a chest wall mass. Case Presentation A 56-year-old veteran male with no medical history presented with a right-sided chest wall mass. He has been experiencing solid food dysphagia intermittently for the past 15 years. This progressed to liquids as well and was accompanied by worsening gastro-esophageal reflux. During his military service overseas, he endorsed consuming one liter of 40% alcohol on the weekends. Three months prior to presentation, he reported an unintended weight loss of 40lbs due to loss of appetite. In the most recent weeks, the patient’s functional status declined due to diffuse musculoskeletal complaints of neck, back, chest, and abdomen. Physical exam revealed asymmetrical chest wall elevation with right greater than left, otherwise unremarkable. Notable labs on admission were: ALP/ALT/AST: 430 U/L, 60 U/L, 88 U/L, GGT: 519 U/L, and LDH: 627 u/L. He was vitally stable. Imaging of the chest was significant for multiple lesions but most notable was the large chest wall mass (Fig 1B). EGD identified a friable distal esophageal mass (Figure 1A). Biopsy of chest wall mass revealed a poorly differentiated adenocarcinoma with a high probability of upper gastrointestinal origin.Following effective symptomatic management, the patient was discharged with immunotherapy initiation under hematology-oncology. He then returned around one week later and inpatient treatment with FOLFOX was initiated. Discussion Esophageal cancer can be squamous cell carcinoma or adenocarcinoma. The latter is predominantly observed in Western countries, whereas squamous cell carcinoma is prevalent in Eastern countries. The risk factors for esophageal adenocarcinoma include advancing age, male sex, obesity, and gastro-esophageal reflux disease. Alarm symptoms that may suggest malignancy include weight loss, dysphagia, iron deficiency anemia, and occult gastrointestinal bleeding, warranting an immediate endoscopic evaluation. Given our patient’s family history of various cancers, including breast and gastric, extensive molecular testing was conducted to identify potential therapeutic targets. Additionally, patients presenting with a non-typical presentation, such as in this patient, esophageal carcinoma should be considered on the differential diagnosis. This abstract is funded by: None
Khalid et al. (Fri,) studied this question.