title: Metastatic adenocarcinoma of the esophagus to the skin: new patterns of tumor recurrence and alternate treatments for palliation.
abstract: BACKGROUND
  Esophageal cancer, particularly adenocarcinoma of the esophagus (ACE), has been steadily increasing in incidence in the United States. In the past, patients usually died rapidly with locoregional disease that leads to inanition and aspiration. However, today when patients with ACE are treated successfully with induction chemotherapy and radiation therapy, followed by surgical excision, ACE usually does not recur locally, but presents with metatastic disease. We present a 62-year-old white male with ACE, which was treated with induction chemotherapy and radiation therapy followed by surgical excision. After approximately 1 year with no evidence of locoregional recurrence, the patient presented with diffuse cutaneous metastatic disease.
  
  
  METHODS
  In addition to routine staining immunohistochemical stains for CK(AE1/AE3), CK7, CK 20, EMA, alpha-smooth muscle (SM) actin, S-100 protein, CD34, P53, Bcl-2, c-erbB-2 were performed.
  
  
  RESULTS
  The immunohistochemical profile was consistent with an esophageal origin showing positive staining with CK20 and CK7 as well as AE1/AE3 and EMA. In addition, there was marked nuclear expression of p53, as well as membrane expression of c-erb-B2; consistent with progression of the disease and poor response to further cytotoxic therapeutic regimes.
  
  
  CONCLUSIONS
  With new therapeutic protocols, we can expect to see more metastatic disease with recurrences of ACE. The histopathologic features and the immunohistochemical profile of the recurrent tumors may be helpful in determining alternate forms of therapy that either alone or in combination could be useful in palliation and delaying progression.
authors.affiliation: Department of Dermatology, National Naval Medical Center, Bethesda, Maryland, USA. HSkelIII@aol.com
authors.forename: K J
authors.initials: KJ
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Williams
authors.forename: H
authors.initials: H
authors.lastname: Skelton
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D014408:Biomarkers, Tumor / Q000032:analysis; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D010166:Palliative Care; D012878:Skin Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000628:therapy
chemical_list: D014408:Biomarkers, Tumor