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WHO Classification of Tumours
Secondary tumours of the oesophagus


Definition
Tumours of the oesophagus that originate from an extra-oesophageal neoplasm or that are discontinuous with a primary tumour elsewhere in the oesophagus.

Epidemiology
In a series of 4198 cases of malignant oesophageal disease, 114 (2.7%) were metastases from non-oesophageal primary neoplasms

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Rampado S, Ruol A, Guido M, Zaninotto G, Battaglia G, Costantini M, Portale G, Amico A, Ancona E (2007)
Mediastinal carcinosis involving the esophagus in breast cancer: the "breast-esophagus" syndrome: report on 25 cases and guidelines for diagnosis and treatment.
Ann Surg 246: 316-22



. A higher frequency (6.1% of autopsy cases) was reported in Japan
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Mizobuchi S, Tachimori Y, Kato H, Watanabe H, Nakanishi Y, Ochiai A (1997)
Metastatic esophageal tumors from distant primary lesions: report of three esophagectomies and study of 1835 autopsy cases.
Jpn J Clin Oncol 27: 410-4



.

Origin of the metastases
After exclusion of pharyngeal carcinomas, gastric carcinomas and malignant mediastinal neoplasms involving the oesophagus by direct extension, metastatic neoplasms may reach the oesophagus by haematogenous or lymphatic dissemination. Any primary neoplasm is a potential source of haematogenous spread to the oesophagus, whereas lymphatic spread is mainly seen in association with breast and lung tumours. The most common origins of oesophageal metastases are breast and lung carcinomas, followed by melanoma

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Libshitz HI, Lindell MM, Dodd GD (1982)
Metastases to the hollow viscera.
Radiol Clin North Am 20: 487-99




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Mizobuchi S, Tachimori Y, Kato H, Watanabe H, Nakanishi Y, Ochiai A (1997)
Metastatic esophageal tumors from distant primary lesions: report of three esophagectomies and study of 1835 autopsy cases.
Jpn J Clin Oncol 27: 410-4




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Washington K, McDonagh D (1995)
Secondary tumors of the gastrointestinal tract: surgical pathologic findings and comparison with autopsy survey.
Mod Pathol 8: 427-33



. Metastasis from carcinomas of the thyroid, cervix, ovary, prostate and kidney have also been reported
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Cooney BS, Levine MS, Schnall MD (1995)
Metastatic thyroid carcinoma presenting as an expansile intraluminal esophageal mass.
Abdom Imaging 20: 20-2




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Lee B, Cook G, John L, Harrington K, Nutting C (2008)
Follicular thyroid carcinoma metastasis to the esophagus detected by 18FDG PET/CT.
Thyroid 18: 267-71




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Mizobuchi S, Tachimori Y, Kato H, Watanabe H, Nakanishi Y, Ochiai A (1997)
Metastatic esophageal tumors from distant primary lesions: report of three esophagectomies and study of 1835 autopsy cases.
Jpn J Clin Oncol 27: 410-4




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Nakamura T, Mohri H, Shimazaki M, Ito Y, Ohnishi T, Nishino Y, Fujihiro S, Shima H, Matsushita T, Yasuda M, Moriwaki H, Muto Y, Deguchi T (1997)
Esophageal metastasis from prostate cancer: diagnostic use of reverse transcriptase-polymerase chain reaction for prostate-specific antigen.
J Gastroenterol 32: 236-40




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Trentino P, Rapacchietta S, Silvestri F, Marzullo A, Fantini A (1997)
Esophageal metastasis from clear cell carcinoma of the kidney.
Am J Gastroenterol 92: 1381-2



.

Localization
The most common site of haematogenous metastases is the middle third of the oesophagus.

Clinical features
Metastatic lesions typically form symptomatic or asymptomatic submucosal nodules, but may also produce large symptomatic, obstructive tumours

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Simchuk EJ, Low DE (2001)
Direct esophageal metastasis from a distant primary tumor is a submucosal process: a review of six cases.
Dis Esophagus 14: 247-50



. The most common symptom is dysphagia; achalasia, haematemesis, weight loss and anaemia are less commonly seen
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Ayantunde AA, Agrawal A, Parsons SL, Welch NT (2007)
Esophagogastric cancers secondary to a breast primary tumor do not require resection.
World J Surg 31: 1597-601




Click to access Pubmed
Rampado S, Ruol A, Guido M, Zaninotto G, Battaglia G, Costantini M, Portale G, Amico A, Ancona E (2007)
Mediastinal carcinosis involving the esophagus in breast cancer: the "breast-esophagus" syndrome: report on 25 cases and guidelines for diagnosis and treatment.
Ann Surg 246: 316-22




Click to access Pubmed
Sobel JM, Lai R, Mallery S, Levy MJ, Wiersema MJ, Greenwald BD, Gunaratnam NT (2005)
The utility of EUS-guided FNA in the diagnosis of metastatic breast cancer to the esophagus and the mediastinum.
Gastrointest Endosc 61: 416-20



. The development of new-onset dysphagia in a patient with a known malignancy may suggest an oesophageal metastasis. Although all modes of imaging have value when evaluating oesophageal metastases, endoscopic ultrasound is used most often to define the extent of oesophageal involvement. Minimally invasive thoraco - scopy may facilitate the diagnosis of carcinosis of the oesophagus caused by breast cancer
Click to access Pubmed
Rampado S, Ruol A, Guido M, Zaninotto G, Battaglia G, Costantini M, Portale G, Amico A, Ancona E (2007)
Mediastinal carcinosis involving the esophagus in breast cancer: the "breast-esophagus" syndrome: report on 25 cases and guidelines for diagnosis and treatment.
Ann Surg 246: 316-22




Click to access Pubmed
Simchuk EJ, Low DE (2001)
Direct esophageal metastasis from a distant primary tumor is a submucosal process: a review of six cases.
Dis Esophagus 14: 247-50




Click to access Pubmed
Sobel JM, Lai R, Mallery S, Levy MJ, Wiersema MJ, Greenwald BD, Gunaratnam NT (2005)
The utility of EUS-guided FNA in the diagnosis of metastatic breast cancer to the esophagus and the mediastinum.
Gastrointest Endosc 61: 416-20



.

Histopathology
The histopathology of oesophageal metastases will be most similar to the primary neoplasm of origin. A pertinent clinical history, the submucosal distribution of the lesion, the absence of epithelial surface involvement and the presence of adenocarcinoma in the wall of the squamous lined oesophagus is generally sufficient to distinguish metastatic from primary oesophageal carcinoma. Difficulty may arise when a metastatic squamous cell carcinoma involves the oesophageal mucosa or a metastatic adenocarcinoma infiltrates the lower oesophageal mucosa. In those instances, clinical history and immunohistochemical stains including “organ-specific” markers may help in reaching the diagnosis.

Prognosis and predictive factors
Oesophageal metastasis is a sign of advanced disease, but the outcome is better when the growth rate of the primary tumour is slow

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Oka T, Ayabe H, Kawahara K, Tagawa Y, Hara S, Tsuji H, Kusano H, Nakano M, Tomita M (1993)
Esophagectomy for metastatic carcinoma of the esophagus from lung cancer.
Cancer 71: 2958-61



or when systemic therapy is employed, as for metastatic breast cancer
Click to access Pubmed
Ayantunde AA, Agrawal A, Parsons SL, Welch NT (2007)
Esophagogastric cancers secondary to a breast primary tumor do not require resection.
World J Surg 31: 1597-601




Click to access Pubmed
Rampado S, Ruol A, Guido M, Zaninotto G, Battaglia G, Costantini M, Portale G, Amico A, Ancona E (2007)
Mediastinal carcinosis involving the esophagus in breast cancer: the "breast-esophagus" syndrome: report on 25 cases and guidelines for diagnosis and treatment.
Ann Surg 246: 316-22



.







Christine Iacobuzio-Donahue
Click to contact editor
Christine Iacobuzio-Donahue
Department of Pathology
The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions
Baltimore
USA




Gabriel M. Groisman
Click to contact editor
Gabriel M. Groisman
Department of Pathology
Hillel Yaffe Medical Center
Hadera
ISRAEL





Primary melanoma of the oesophagus.
Primary melanoma of the oesophagus.

Primary malignant melanoma of the distal  oesophagus.
Primary malignant melanoma of the distal oesophagus.