An unusual presentation of metastatic esophageal adenocarcinoma presenting as thigh pain

The association between esophageal adenocarcinoma and distant skeletal muscle metastasis is extremely rare. Only three cases have been previously reported in the literature. All reported involvement of the gastroesophageal junction. We describe a 58 year-old Caucasian man who presented with worsening right hip pain for nine months. Computerized axial tomography (CT) scan demonstrated a 10 cm by 8 cm by 12 cm intra-pelvic mass involving the right iliacus muscle with central destruction of the right mid-ileum. CT-guided biopsy of the right hip mass demonstrated poorly differentiated carcinoma. CT scan of the chest revealed a 5 cm by 4 cm circumferential mass involving the distal esophagus. Endoscopic biopsy showed poorly differentiated adenocarcinoma. Immunohistochemical analysis of each specimen correlated for pancytokeratin. Final diagnosis was primary esophageal adenocarcinoma with distant metastasis to the right ileum and iliacus muscle. We review distinctions between esophageal adenocarcinoma and adenocarcinoma of the gastroesophageal junction. A brief discussion of diagnostic modalities and treatment options are provided.