Shibata Y, Ohmura H, Komatsu K, Sagara K, Matsuyama A, Nakano R, Baba E. Myocardial metastasis from ZEB1- and TWIST-positive spindle cell carcinoma of the esophagus: A case report. World J Gastroenterol 2024; 30(11): 1636-1643 [PMID: 38617457 DOI: 10.3748/wjg.v30.i11.1636]
Corresponding Author of This Article
Eishi Baba, MD, PhD, Professor, Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. baba.eishi.889@m.kyushu-u.ac.jp
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yoshihiro Shibata, Kosuke Sagara, Department of Medical Oncology, Fukuoka Wajiro Hospital, Fukuoka 811-0213, Japan
Hirofumi Ohmura, Eishi Baba, Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
Kazuki Komatsu, Department of Pathology and Oncology, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
Atsuji Matsuyama, Ryuji Nakano, Department of Diagnostic Pathology, Fukuoka Wajiro Hospital, Fukuoka 811-0213, Japan
Author contributions: Shibata Y, Ohmura H, and Baba E contributed to the design of the report and drafted the manuscript; Komatsu K, Sagara K, Matsuyama A, and Nakano R critically revised the manuscript.
Informed consent statement: Written, informed consent was obtained from the patient’s next of kin for publication of the details of the patient’s medical case and any accompanying images.
Conflict-of-interest statement: Hirofumi Ohmura has received speakers’ bureau from Ono Pharmaceutical; Eishi Baba has received honoraria from Ono Pharmaceutical and Bristol-Myers Squibb; All other authors have no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Eishi Baba, MD, PhD, Professor, Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. baba.eishi.889@m.kyushu-u.ac.jp
Received: January 19, 2024 Peer-review started: January 19, 2024 First decision: January 31, 2024 Revised: February 2, 2024 Accepted: March 7, 2024 Article in press: March 7, 2024 Published online: March 21, 2024 Processing time: 62 Days and 6.3 Hours
Abstract
BACKGROUND
Metastatic cardiac tumors are known to occur more frequently than primary cardiac tumors, however, they often remain asymptomatic and are commonly discovered on autopsy. Malignant tumors with a relatively high frequency of cardiac metastasis include mesothelioma, melanoma, lung cancer, and breast cancer, whereas reports of esophageal cancer with cardiac metastasis are rare.
CASE SUMMARY
The case of a 60-year-old man who complained of dysphagia is presented. Upper gastrointestinal endoscopy showed a submucosal tumor-like elevated lesion in the esophagus causing stenosis. Contrast-enhanced computed tomography showed left atrial compression due to the esophageal tumor, multiple liver and lung metastases, and a left pleural effusion. Pathological examination of a biopsy specimen from the esophageal tumor showed spindle-shaped cells, raising suspicion of esophageal sarcoma. The disease progressed rapidly, and systemic chemotherapy was deemed necessary, however, due to his poor general condition, administration of cytotoxic agents was considered difficult. Given his high Combined Positive Score, nivolumab was administered, however, the patient soon died from the disease. The autopsy confirmed spindle cell carcinoma (SCC) of the esophagus and cardiac metastasis with similar histological features. Cancer stem cell markers, ZEB1 and TWIST, were positive in both the primary tumor and the cardiac metastasis.
CONCLUSION
To the best of our knowledge, there have been no prior reports of cardiac metastasis of esophageal SCC. This case highlights our experience with a patient with esophageal SCC who progressed rapidly and died from the disease, with the autopsy examination showing cardiac metastasis.
Core Tip: Spindle cell carcinoma (SCC) is rare, accounting for about 0.1%-1.5% of esophageal cancers. Tumor cells show sarcomatoid differentiation with spindle cells and are accompanied by components of conventional carcinoma including squamous cell carcinoma in some cases. Many of cardiac metastatic tumors are asymptomatic and are typically discovered through pathological autopsy, with metastatic cardiac tumors being identified in 2% to 18% of cancer patients undergoing autopsy. There has been no report of cardiac metastasis in esophageal SCC.
