Metastatic adenocarcinoma of the esophagus to the skin: new patterns of tumor recurrence and alternate treatments for palliation

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 lead s to inanition and aspiration. However, today when patients with ACE are tr eated successfully with induction chemotherapy and radiation therapy, follo wed by surgical excision, ACE usually does not recur locally, but presents with metatastic disease. We present a 62-year-old white male with ACE, whic h was treated with induction chemotherapy and radiation therapy followed by surgical excision. After approximately 1 year with no evidence of locoregi onal recurrence, the patient presented with diffuse cutaneous metastatic di sease. 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 E MA. In addition, there was marked nuclear expression of p53, as well as mem brane expression of c-erb-B2; consistent with progression of the disease an d poor response to further cytotoxic therapeutic regimes. Conclusions: With new therapeutic protocols, we can expect to see more meta static disease with recurrences of ACE. The histopathologic features and th e immunohistochemical profile of the recurrent tumors may be helpful in det ermining alternate forms of therapy that either alone or in combination cou ld be useful in palliation and delaying progression.