Published online Feb 24, 2020. doi: 10.5306/wjco.v11.i2.83
Peer-review started: July 7, 2019
First decision: August 20, 2019
Revised: November 23, 2019
Accepted: December 19, 2019
Article in press: December 19, 2019
Published online: February 24, 2020
Processing time: 232 Days and 6.8 Hours
Pancreatic adenocarcinoma is an aggressive malignancy with a high propensity to metastasize. Esophageal metastasis manifesting as dysphagia is rarely reported in the literature and has not to our knowledge been reported prior to the appearance of the primary disease.
A patient presented with progressive dysphagia to solids and a persistent earache. Computed tomography of the neck and chest revealed a 3.0 cm × 1.8 cm heterogeneous mass originating from the upper third of the esophagus, necrotic cervical and supraclavicular lymphadenopathy, and bilateral pulmonary nodules. She underwent a core needle biopsy of a right cervical node, which suggested a well-differentiated adenocarcinoma of unknown primary. She had an upper endoscopy with biopsy of the esophageal mass suggestive of a well-differentiated adenocarcinoma. Positron emission tomography imaging revealed increased uptake in the esophageal mass, cervical, and mediastinal lymph nodes. She was started on folinic acid, fluorouracil, and oxaliplatin. Prior to initiation of cycle 8, the patient was found to have a pancreatic body mass that was not present on prior radiographic imaging, confirmed by endoscopic ultrasonography and biopsy to be pancreatic adenocarcinoma. CA19-9 was > 10000 U/mL, suggesting a primary pancreaticobiliary origin.
Esophageal metastasis diagnosed before primary pancreatic adenocarcinoma is rare. This case highlights the profound metastatic potential of pancreatic adenocarcinoma.
Core tip: Pancreatic adenocarcinoma is an aggressive malignancy with a high mortality rate and propensity to metastasize. We present a rare case of metastatic pancreatic adenocarcinoma to the esophagus and cervical lymph nodes presenting as dysphagia and an earache months before the primary pancreatic mass was detected on radiographic imaging. This case highlights the highly aggressive nature of pancreatic adenocarcinomas and the metastatic potential early in the disease course. In the setting of metastatic adenocarcinoma of unknown primary, clinicians should consider the possibility of a pancreatic origin.