Esophageal Adenocarcinoma with Solitary Renal Metastasis
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CASE REPORT
Esophageal Adenocarcinoma with Solitary Renal Metastasis Thomas D. Willson & Matthew J. Blecha & Mark M. Connolly & Francis J. Podbielski
Published online: 30 November 2012 # Springer Science+Business Media New York 2012
Introduction Esophageal cancer is a less common malignancy of the gastrointestinal tract and continues to have a dismal prognosis despite screening programs for high-risk patients. Patients frequently present with advanced disease, and 5-year survival is 18.1 % on average [1]. Of esophageal cancers in the USA, 59 % are adenocarcinomas, while squamous cell lineages represent another 34.5 % [1]. Metastases are common at the time of presentation with 18–50 % of patients having distant or unresectable disease [1–3]. Despite poor overall survival, surgical resection remains a mainstay of curative therapy for esophageal cancer [4]. Most esophageal tumors are responsive to chemotherapy or combined chemoradiotherapy, and thus neoadjuvant therapy is recommended for patients with node-positive disease and those found to have T3 tumors on preoperative endoscopic ultrasonography. This treatment results in down-staging the primary tumor and eventual resection [2]. In practice, 40– 63 % of patients who undergo curative esophagectomy ultimately develop recurrence of their disease [4–7]. The median time to recurrence is 11–12 months [4, 5]. The pattern of esophageal cancer recurrence and metastasis is of interest given the emphasis on surgical treatment of these patients and the ongoing controversy as to whether an interventional approach to recurrence offers any survival benefit compared to symptomatic treatment [4, 5]. Visceral metastases and recurrences, including the kidney, are common [3, 6, 8–11]. Most metastases, however, are small, multiple, and bilateral [7, 9, 11, 12]. Solitary, isolated metastases from any T. D. Willson (*) : M. J. Blecha : M. M. Connolly : F. J. Podbielski Department of Surgery, Saint Joseph Hospital, 2900 N Lake Shore Drive, Chicago, IL 60613, USA e-mail: [email protected]
cancer to the kidney are rare [12, 13]. There have been occasional reports of renal metastases from esophageal squamous cell carcinoma, but not from esophageal adenocarcinoma as is reported in this case [7, 9, 11, 14].
Case Report A 59-year old man was evaluated for a 4-month history of vague difficulties in swallowing and substernal chest pain. He had a 60 pack-year history of smoking and only rare alcohol use. As an adolescent, he was employed by an asbestos installation firm. Later in his career, the patient worked for an asbestos removal company. Initial endoscopy demonstrated a nearly obstructing, circumferential, nodular tumor at 40 cm from the incisors. Biopsy revealed a poorly differentiated adenocarcinoma with signet ring cells. Staging via PET-CT demonstrated the esophageal tumor and evidence of celiac nodal disease. The patient underwent neoadjuvant chemotherapy and radiation with the aim of down-staging the tumor. Follow-up imaging studies revealed only the esophageal mass a
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