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Case Reports
. 2024 Jul 4;16(7):e63855.
doi: 10.7759/cureus.63855. eCollection 2024 Jul.

Gastroesophageal Junction Adenocarcinoma With Skeletal Muscle Metastases: A Case Report and Literature Review

Jacob Sabu  1 , Aye M Thida  2 , Gyuhee Seong  1 , Amena Mohiuddin  2 , Hagar Attia  3 , Maksim Agaronov  3 , Edwin Chiu  2
Affiliations
Case Reports

Gastroesophageal Junction Adenocarcinoma With Skeletal Muscle Metastases: A Case Report and Literature Review

Jacob Sabu et al. Cureus. .

Abstract

Esophageal and gastroesophageal junction (GEJ) malignancies are aggressive, and survival is poor once metastasis occurs. The most common sites of metastatic involvement include the liver, lymph nodes, lung, peritoneum, adrenal glands, bone, and brain, while skeletal muscle (SM) involvement is rare. We report a case of a 68-year-old female who presented with intractable emesis for one month and was found to have a primary GEJ adenocarcinoma measuring up to 6.7 cm. Endoscopic biopsy revealed poorly differentiated GEJ adenocarcinoma with positive AE1/AE3 immunostains. Positron emission tomography/computed tomography and magnetic resonance imaging revealed metastases to the omentum and left lower extremity SMs, including the proximal adductor longus, adductor magnus, and gluteus minimus. This study reviews the literature on SM metastasis in esophageal and GEJ cancer, GEJ cancer classification, incidence, treatment, and prognosis.

Keywords: ac-adenocarcinoma; esophageal cancer (ec); esophagus adenocarcinoma; gastroesophageal adenocarcinoma; gastroesophageal cancer; gastroesophageal junction (gej); muscle metastasis; rare metastasis; skeletal muscle metastasis.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT abdomen/pelvis with contrast showing a GEJ mass. GEJ mass measuring up to 6.7 cm (red arrow). Distal gastric fundus ulceration is adjacent to the GEJ, with concern for perforation (blue arrow)
CT: computed tomography; GEJ: gastroesophageal junction
Figure 2
Figure 2. GEJ mass biopsy. (A) Hematoxylin and eosin, original magnifications 100×. (B) Hematoxylin and eosin, original magnifications 200×, showing moderately to poorly formed malignant glands. (C) The glands are positive for cytokeratin AE1/AE3 on IHC. (D) The glands are negative for p40 on IHC
GEJ: gastroesophageal junction; IHC: immunohistochemistry
Figure 3
Figure 3. PET/CT. FDG avid necrotic distal esophagus and gastric fundus lesion (red arrow), SUV max 14, consistent with biopsy-proven adenocarcinoma of the esophagus. Focal FDG avidity along the proximal left adductor muscle (blue arrow), SUV max 6.49, representing intramuscular metastasis. FDG avid left adrenal nodule measuring up to 2 x 1.5 cm, SUV max 7.02, likely metastatic in etiology. FDG avid right lower quadrant peritoneal soft-tissue attenuation lesion measuring 2.4 x 1.8 cm, SUV max 8.7, likely reflective of peritoneal metastasis (green arrow)
PET/CT: positron emission tomography/computed tomography; FDG: fludeoxyglucose F18; SUV max: maximum standardized uptake value
Figure 4
Figure 4. Omental biopsy. (A) Hematoxylin and eosin, original magnifications 40×. (B) Hematoxylin and eosin, original magnifications 200×, exhibiting infiltration of the omental fat by malignant glands indicative of metastatic adenocarcinoma from the GEJ mass
GEJ: gastroesophageal junction
Figure 5
Figure 5. MRI of the left femur with contrast demonstrating a 1.2 x 1.2 x 2.5 cm enhancing lesion within the proximal left adductor longus muscle, which corresponded to the hypermetabolic focus seen on PET/CT scan (blue arrow)
MRI: magnetic resonance imaging; PET/CT: positron emission tomography/computed tomography
Figure 6
Figure 6. SM biopsy. (A) Hematoxylin and eosin, original magnifications 100×. (B) Hematoxylin and eosin, original magnifications 200×. (C) Hematoxylin and eosin, original magnifications 400×: biopsy of the muscle involved by metastatic adenocarcinoma with infiltrative moderately to poorly formed malignant glands
SM: skeletal muscle
See this image and copyright information in PMC

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