Rare Metastasis of Esophago-Gastric Cancers: Case series with review of literature

Abstract

Purpose: in this case series we aim to highlight rare metastasis of gastric and esophageal cancers metastasizing to unusual locations causing a diagnostic challenge on presentation. We also review pertinent literature of rare locations of metastasis of gastro-esophageal cancer (GEC). Materials and methods: this is a retrospective analysis of four patients managed at our institution with one year follow up between 2020-2021. We include baseline patient characteristics, presenting symptoms, diagnostic work up and management of each individual case. Results: Out of the 4 cases with GEC; two had gastric adenocarcinoma, one esophageal adenocarcinoma and one gastroesophageal junction adenocarcinoma which metastasized to various locations throughout the body. Among the rarest locations of metastasis of gastric cancer is skeletal muscles. The locations of metastases were: ovaries and peritoneum from gastric adenocarcinoma, brain and liver from gastric adenocarcinoma, skeletal muscles from esophageal adenocarcinoma, and skeletal muscles and breast from GEC adenocarcinoma. The main diagnostic tool to identify these rare sites metastasis was Positron emission tomography scan (PET/CT). Conclusion: Studies have shown that not all gastroesophageal malignancies present with these alarm symptoms and up to 40% of patient can present without alarming symptoms. In our study; we shed the light on the possible rare metastatic sites that could have been missed with the regular presentation. Some of the rarest location of metastasis is to the skeletal muscles, which was present in two of our patients with an origin of gastric and esophageal cancer, which was identified with PET/CT. This study clarifies the importance of including whole body PET/CT scan in the staging process for patients with esophageal and gastric cancers to identify such rare sites metastasis that will alter the stage and clinical management of GEC patients.