Endotracheal metastasis from basaloid squamous carcinoma of the esophagus – A case report Running Head: Endotracheal metastasis of esophageal cancer
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چکیده
Endobronchial metastases from extrapulmonary neoplasms are rare events and there is no report on the metastasis originating from esophageal cancer. Basaloid squamous carcinoma of the esophagus is a rare histologic type, which is known as biologically aggressive phenotype. We describe a rare case of metachronous endotracheal metastasis originating from esophageal basaloid squamous carcinoma. A 72-year-old Japanese man underwent esophagectomy for stage I esophageal cancer. Pathological diagnosis of the resected specimen was basaloid squamous carcinoma. One year later, a follow-up computed tomography displayed a tumorshadow in the tracheal wall. Bronchoscopy revealed a protruding tumor in the tracheal wall and pathologic diagnosis of the biopsy specimen was also basaloid squamous carcinoma. Under the diagnosis of metachronous endobronchial metastasis from esophageal basaloid squamous carcinoma, we treated the patients with chemotherapy containing Docetaxel, cisplatin and 5-fluorouracil followed by chemoradiotherapy and then complete response was achieved. The patient has been alive without disease for 23 months since the diagnosis of endobronchial tumor. A careful follow-up is needed not to miss the rare type of metastasis in cases with biologically aggressive tumors. INTRODUCTION An endobronchial metastasis of extrapulmonary solid neoplasms is rare [1, 2]. Although various tumors have been associated with endobronchial metastasis [2], there is no report of endobronchial metastasis from esophageal origin. Basaloid squamous carcinoma of the esophagus is a rare histologic type, which is known as biologically aggressive phenotype [3]. We herein report a rare case with metachronous endotracheal metastasis from basaloid squamous carcinoma of the esophagus, successfully treated with chemotherapy followed by chemoradiotherapy. CASE REPORT A 72-year-old Japanese man underwent esophagectomy for clinical stage I esophageal cancer. Gross appearance of the esophageal tumor was 0-Ip+IIc type (Figure 1A). Microscopically, the polypoid tumor consisted of nests of tumor cells with round to ovoid nucleus and scanty cytoplasm, and basal membrane-like structures were observed among the tumor nests (Figure 1B, 1C). A histopathologic diagnosis was basaloid squamous carcinoma limited within the submucosal layer. Neither lymph node metastasis nor lymphatic invasion was observed while venous invasion was obvious. One year later, a follow-up computed tomography displayed a tumor shadow inside the tracheal wall (Figure 2). A bronchoscopy revealed a protruding tumor in the trachea (Figure 3). Biopsy under bronchoscopy presented solid nests of
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