Intramural Gastric Metastasis: A Rare Presentation of Esophageal Squamous Cell Carcinoma

Abstract

Intramural gastric metastasis of the esophageal carcinoma, excluding the direct extension of primary neoplasm, is rare. However, intramural metastasis to the esophagus is commoner than this. These are more common in squamous cell carcinoma variant. This signifies a poor prognosis. It is due to the spread of pathology through the intramural lymphatic channels. Sometimes the metastatic lesion is more extensive in volume than the primary. This is more often diagnosed on histopathology in postoperative specimens. We share our imaging experience with surface esophageal squamous cell carcinoma with giant intramural gastric metastasis infiltrating the liver in a 39-year-old male. Due to its rarity, and secondary lesion being more extensive than the primary leads to misinterpretation and wrong diagnosis. Knowledge of this rare phenomenon can prevent misdiagnosis, fasten the imaging workup, and ultimately improve the patient's survival.

Keywords: Lymphatic spread of esophageal neoplasm; mucosal oesophageal carcinoma; secondary gastric neoplasm; submucosal tumor of the stomach.

Figure 1

Ultrasonography abdomen done at right hypochondrium in the transverse plane (a), and epigastrium in sagittal/longitudinal plane (b) showing a heterogeneously hypoechoic intraluminal mass in the stomach (curved arrow), intraluminal air/fluid (arrow), and infiltration in the liver parenchyma (arrowhead)

Figure 2

Upper gastrointestinal barium study in anteroposterior erect (a), right posterior oblique (b), and left posterior oblique (c) view showing a filling defect in the lower esophagus (solid white arrow) and upper stomach (solid black arrow). Note the normal-appearing barium column between two filling defects

Figure 3

Axial contrast-enhanced computed tomography at the level of the lower esophagus (a), the stomach (b and c), and coronal contrast-enhanced computed tomography (d) showing heterogeneously enhancing esophageal (arrow) and gastric mass lesion (curved arrow) with adjacent liver infiltration (arrowhead)

Figure 4

Upper gastrointestinal endoscopy images showing ulcero-proliferative growth involving distal esophagus (a) and proximal as well as mid gastric body (b)

Figure 5

Histopathology examinations showing squamous epithelium of esophagus with neoplastic tissue (H and E, ×4 [a]), necrosis [H and E, ×10 [b]), polygonal cells with vesicular chromatin, and occasional nucleoli [H and E, ×40 [c])]. AB-PAS stain (d) showing no intracellular mucin