Myocardial metastasis from ZEB1- and TWIST-positive spindle cell carcinoma of the esophagus: A case report

Figure 1 Imaging of primary lesion by upper gastrointestinal endoscopy. Upper gastrointestinal endoscopy shows a submucosal tumor-like protruding lesion occupying nearly the entire lumen from the mid to lower thoracic esophagus, causing stenosis.

Figure 2 Imaging of primary and metastatic lesions by computed tomography. A: Contrast-enhanced computed tomography shows left atrial compression due to the esophageal tumor; B: Multiple liver metastases; C: Multiple lung metastases and left pleural effusion.

Figure 3 ZEB1 and TWIST in primary and metastatic cardiac lesions. Cancer stem cell markers ZEB1 and TWIST are immunohistologically positive in both the primary and metastatic cardiac lesions. A: ZEB1 staining of the primary lesion; B: ZEB1 staining of the cardiac lesion; C: TWIST staining of primary lesion; D: TWIST staining of the cardiac lesion.

Figure 4 Autopsy examination findings. A: Numerous disseminated nodules are observed in the left pleural cavity; B: Multiple metastases in the liver; C: Multiple metastases in the lung; D: Multiple metastases in the heart.