Metastasis to the esophagus from primary adenocarcinoma of the lung

Background: Metastasis to the esophagus is a rare event that can occur by direct infiltration of malignancies from nearby organs or, more infrequently, via lymphatic or hematogenous spread. Methods: We reviewed the hospital charts of a patient presenting with dysphagia in whom a distant metastasis to the esophagus from a primary lung adenocarcinoma was documented. A review of the pertinent literature was performed. Results: A 74 year-old man with previous history of lung cancer and transoral septum stapling for Zenker’s diverticulum presented with subtotal dysphagia and chest pain. On upper gastrointestinal endoscopy, a vegetating mass of the middle esophagus, covered by fragile and bleeding mucosa, was found. Esophageal biopsies demonstrated metastasis from a poorly differentiated lung adenocarcinoma with evidence of thyroid transcription factor (TTF) positive neoplastic cells. A computed tomography scan revealed a radiopaque mass in the upper right lung. Combination chemotherapy was initiated and a partially covered stent was placed endoscopically. Conclusions: A distant metastatic tumor to the esophagus with mucosal infiltration is an exceptional event. In our patient, immunohistochemistry was useful to confirm the diagnosis of primary lung carcinoma.