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Z Gastroenterol 2015; 53(02): 115-119
DOI: 10.1055/s-0034-1398791
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Unusual relationship between skin lesions and esophageal cancer: a case report and review of literature

Ungewöhnliche Beziehung zwischen Hautläsionen und Ösophaguskarzinom: ein Fallbericht und eine Literaturübersicht
F. Moreno Racionero
,
B. de Andres Asenjo
,
M. Bedate Nuñez
,
P. Legido Moran
,
C. Ortega loubon
,
J. Rabadán Jimenez
,
J. Beltran de Heredía y Rentería
Further Information

Publication History

15 June 2014

14 December 2014

Publication Date:
10 February 2015 (online)

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Abstract

Esophageal cancer is a rare disease. In Spain, this tumor is the third most common gastrointestinal malignancy after colorectal and gastric cancer. Esophageal adenocarcinoma metastasizes to the skin with an incidence of 1 %, generally located in the neck, head and abdomen. It usually occurs in the overlying skin of the primary tumor, but may also appear in a distant site, the scalp being the most common place. Although the pathogenesis of esophageal adenocarcinoma is not well known, the existence of genetic alterations, such as the suppressor gene, has been proved and the involvement of oncogene c-erbB-2 amplified. Cytokeratin 20 and 7 are expressed in esophageal adenocarcinoma. Typically, cutaneous metastases from internal malignancy present as firm asymptomatic nodules. These nodules usually occur in multiple arrays on the skin adjacent to the primary tumor; however, they can occasionally become painful spontaneously. The main diagnostic test of esophageal cancer is the upper endoscopy, along with histopathology for confirmation of the tumor. The developments in surgery and the discovery of new cytotoxic agents have considerably decreased the locoregional recurrence. To date, the combination of these treatment modalities for advanced adenocarcinoma revealed that the recurrences mainly occur from hematic spread. Excision of the skin lesions produces pain palliation. In patients diagnosed with esophageal cancer who have responded satisfactorily to treatment with chemotherapy, radiation and surgery while having a long history of remission, and dermatology outpatient visits by the appearance of skin lesions, should make us think among the different differential diagnoses, the possibility of cutaneous metastases.

Zusammenfassung

Ösophaguskarzinome stellen eine seltene Tumorentität dar. In Spanien ist das Ösophaguskarzinom der dritthäufigste Tumor des Magen-Darm-Traktes nach Kolon- und Magenkarzinomen. Adenokarzinome der Speisenröhre metastasieren mit einer Wahrscheinlichkeit von 1 % in die Haut (v. a. Nacken, Hals und Abdomen). Meistens treten die Hautmetastasen in der Nähe des Primärtumors auf. Manifestationen in entfernteren Bereichen sind ebenfalls beschrieben, wobei die Kopfhaut am häufigsten betroffen ist. Die Pathogenese des Ösophaguskarzinoms ist bis dato nicht gut verstanden. Genetische Veränderungen in Tumor-Suppressor-Genen bzw. die Beteiligung von Onkogen (z. B. c-erbB-2) sind nachgewiesen. Adenokarzinome des Ösophgus exprimieren Cytokeratin 20 und 7. Hautmetastasen solider Tumoren manifestieren sich typischerweise als symptomlose Knoten in der Nähe des Primärtumors, die spontan auch schmerzhaft sein können. Die Gastroskopie mit Biopsie stellt das Verfahren der Wahl zur Sicherung eines Ösophaguskarzinoms dar. Die Weiterentwicklung chirurgischer Techniken und die Entdeckung neuer zytotoxischer Medikamente hat zu einer deutlichen Senkung der lokoregionären Rezidivrate geführt, sodass heutzutage ein Rezidiv des fortgeschrittenen Adenokarzinoms durch eine hämatogene Streuung bedingt ist. Die Exzision der Hautläsionen führt zur Schmerzlinderung. Patienten mit Ösophaguskarzinomen mit gutem Ansprechen nach Chemotherapie, Bestrahlung und Operation haben eine lange Remissionszeit. Aus diesem Grund sollten Hautärzte bei der amulanten Untersuchung von Patienten mit neu aufgetretenen Hautläsionen differenzialdiagnostisch an die Möglichkeit von Hautmetastasen denken.

Schlüsselwörter

Ösophagus - Krebs - Barrett-Ösophagus - Hautmetastasen - oberen Magen-Darm-Tumoren - Fallbericht und Literatur

Key words

esophagus - cancer - Barrett's esophagus - skin metastases - uper GI tract - case report and literature review
 

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