title: Esophageal squamous cell carcinoma with dural and bone marrow metastases.
abstract: Patients with esophageal squamous cell carcinoma generally present at an advanced stage at the time of diagnosis. The most common sites of visceral metastasis are the lung, liver and bone, but brain and bone marrow involvement is exceedingly rare. Herein, we report a 62-year-old man with a 4-wk history of progressive low back pain with radiation to bilateral lower legs, dysphagia and body weight loss. Esophageal squamous cell carcinoma with regional lymph node, liver and bone metastases was diagnosed. He underwent concurrent chemoradiotherapy and got a partial response. Four months later, he complained of headache, diplopia and severe hearing impairment in the left ear. There was no evidence for bacterial, fungal, tuberculous infection or neoplastic infiltration. Magnetic resonance imaging of the brain demonstrated thickening and enhancement of bilateral pachymeninges and multiple enhancing masses in bilateral skull. Dural metastasis was diagnosed and he received whole brain irradiation. In addition, laboratory examination revealed severe thrombocytopenia and leucopenia, and bone marrow study confirmed the diagnosis of metastatic squamous cell carcinoma. This is the first described case of esophageal squamous cell carcinoma with dural and bone marrow metastases. We also discuss the pathogenesis of unusual metastatic diseases and differential diagnosis of pachymeningeal thickening.
authors.affiliation: Yen-Hao Chen, Cheng-Hua Huang, Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Yen-Hao
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Yen-Hao Chen, Cheng-Hua Huang, Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Cheng-Hua
authors.initials: CH
authors.lastname: Huang
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D019046:Bone Marrow Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D059248:Chemoradiotherapy; D016371:Cranial Irradiation; D003937:Diagnosis, Differential; D004388:Dura Mater / Q000737:chemistry / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy; D000077277:Esophageal Squamous Cell Carcinoma; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Bone marrow metastasis; Dural metastasis; Esophageal cancer; Squamous cell carcinoma