Abstract
PurposeWe report a very unique case of an esophageal metastasis from a pancreatic ductal adenocarcinoma (PDAC) primary.MethodsAfter obtaining consent from the patient, all relevant records of the case were obtained and retrospectively reviewed.ResultsAt presentation, the patient was diagnosed with synchronous pancreatic and esophageal cancer. He received six months of neoadjuvant therapy including FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and stereotactic body radiation therapy (SBRT) to the pancreatic tumor followed by a combined pancreaticoduodenectomy and Ivor Lewis esophagectomy. Review of the final esophageal specimen revealed normal overlying squamous mucosa with an underlying focus of metastatic PDAC. The patient remains alive with no evidence of disease 17 months from surgery and 25 months from diagnosis.ConclusionsDifferentiating an esophageal metastasis from a PDAC primary versus a synchronous esophageal carcinoma is very difficult despite state-of-the-art diagnostic techniques performed at a high-volume tertiary cancer center. Extensive evaluation and continued follow-up of PDAC patients presenting with a synchronous esophageal lesion in a multidisciplinary setting may help ensure efficient and accurate management. In our case, neoadjuvant FOLFIRINOX and SBRT to the primary PDAC tumor followed by surgery has been an effective approach for this patient.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of death by a solid malignancy in the United States, with a 5-year overall survival rate of 8%. [1] PDAC is highly aggressive and often diagnosed at an advanced stage due to the inability to detect early symptoms
We report the 2nd case of a metastasis to the esophagus arising from a PDAC primary reported in the modern era. [7,8,9,10,11,12,13]
A 72-year-old non-smoking male presented with a 6-month history of weight loss (9 kg) followed by obstructive jaundice characterized by a 2-month history of acholic stools and dark urine
Summary
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of death by a solid malignancy in the United States, with a 5-year overall survival rate of 8%. [1] PDAC is highly aggressive and often diagnosed at an advanced stage due to the inability to detect early symptoms. PDAC most commonly metastasizes to lymph nodes, the liver, lung, and peritoneal cavity, while rare locations that have been reported include bone, brain, myocardium, and the umbilicus. [3, 4] At this time, there are few known cases of isolated esophageal metastasis from a pancreatic primary. Metastases to the esophagus are extremely rare, with rates ranging from 4-11% in patients with primaries of the lung, breast, and stomach. Is a PDAC metastasis to the esophagus extremely rare, but it is difficult to distinguish an esophageal primary from a metastasis to the esophagus by radiographic imaging or endoscopy. We report the 2nd case of a metastasis to the esophagus arising from a PDAC primary reported in the modern era (since the 1980s). We report the 2nd case of a metastasis to the esophagus arising from a PDAC primary reported in the modern era (since the 1980s). [7,8,9,10,11,12,13]
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