Abstract
Multiple primary tumors are uncommon in patients with squamous cell esophageal cancer. Conventional imaging methods have limitations in detecting those tumors. Although 18-F-fluoro-deoxyglucose-positron emission tomography scanner increases the detection of multiple synchronous tumors in patients with other malignancies, its contribution in patients with squamous cell esophageal cancer has not been assessed as it is not systematically performed. The detection of synchronous skin squamous cell tumors in patients with squamous cell esophageal cancer presents a challenge for making diagnostic and therapeutic decisions. A metastatic tumor leads to palliative management, whereas the diagnosis of a primary skin tumor requires curative treatment of both squamous cell tumors. Pathological evaluation appears crucial in the decision.
Highlights
In case of patients unfit for surgery the Tokio Multiple primary tumors (MPT) are present in 5-10% of patients with squamous cell esophageal cancer (SCEC) [1,2,3]
The diagnosis of esophageal cancer is based on an endoscopic biopsy and classifying its histology according to the World Health Organization (WHO) criteria [12]
The detection of MPT in patients with SCEC presents a challenge for making therapeutic decisions
Summary
In case of patients unfit for surgery (due to co-morbidities) the Tokio Multiple primary tumors (MPT) are present in 5-10% of patients with squamous cell esophageal cancer (SCEC) [1,2,3]. There are few reports of skin involvement in patients with SCEC, with an incidence of < 1% [6] Conventional imaging methods, such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), have limitations in detecting multiple primary tumors [7]. The 18F-FDG-PETSCAN showed, in addition to hypermetabolic signs of the locally advanced primary esophageal tumor, an intensely hypermetabolic subcutaneous occipital nodular thickening suggestive of metastatic disease Excisional biopsy of this lesion concluded to a moderately differentiated squamous cell carcinoma. A double primary tumor of skin and esophagus was concluded, and resection was indicated with oncological margins of the primary skin lesion and the neoadjuvant radio-chemotherapy with the surgical intention for the esophageal carcinoma
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