Complete resection of an isolated chest wall metastasis from esophageal carcinoma after transhiatal esophagectomy and gastric pull-up at one and a half-year follow-up.
BACKGROUND
In esophageal cancer, the liver, lung, and bones are the most common sites of visceral metastases. Isolated chest wall metastases are quite extraordinary and occur very rarely.


METHODS
In February 2004, a 59-year-old male patient was admitted with esophageal adenocarcinoma. Preoperative routine staging failed to detect any metastases. A transhiatal esophagectomy and retrosternal gastric pull-up with cervical esophago-gastrostomy were performed. The definitive histopathological staging showed an adenocarcinoma, Union Internationale Contre le Cancer stage I. The first check-up 6 months later consisted of a computed tomographic scan of the neck, thorax, and abdomen as well as endoscopy, and raised no suspicion of distant metastases and/or local recurrence. We detected an isolated subcutaneous tumor at the area of the right ventrolateral chest wall 18 months after surgery. The magnetic resonance tomography scan of the thorax showed a solid subcutaneous expansion. The surgical biopsy of this lesion confirmed the suspicion of an isolated chest wall metastasis of the resected esophageal adenocarcinoma.


RESULTS
A complete resection of the metastasis was performed without any complications, and the chest wall deficiency became stabilized using a Prolene-Mesh and could be closed directly by skin and subcutaneous tissue.


CONCLUSIONS
In case of transhiatal esophageal resection without operative participation of the chest wall, an isolated thoracic wall metastasis can be explained by an occult widespread dissemination of the tumor cells along the extensive esophageal lymphatic and hematogenous system. The final decision of surgical resection of this chest wall metastasis should always be made by an interdisciplinary tumor board.
Lindenmann
Joerg
J
Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University School, Graz, Austria. jo.lindenmann@meduni-graz.at
Matzi
Veronika
V
Porubsky
Christian
C
Maier
Alfred
A
Smolle-Juettner
Freyja-Maria
FM
D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016629:Esophagectomy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013899:Thoracic Neoplasms / Q000556:secondary* / Q000601:surgery*; D035441:Thoracic Wall