Synchronous Metastatic Esophageal Squamous Cell Carcinoma and Acute Myeloid Leukemia: A Case Report

Synchronous presentation of solid and hematologic malignancies is uncommon, and coexistence of esophageal squamous cell carcinoma (ESCC) with acute myeloid leukemia (AML) at initial evaluation is exceptionally rare. Cytopenias may be misattributed to malnutrition, chronic disease, or the solid tumor itself.

A 57-year-old Syrian man who was a heavy smoker presented with progressive dysphagia, profound weight loss, weakness, and pallor. Endoscopy revealed a circumferential obstructing esophageal lesion. Computed tomography demonstrated a distal esophageal mass extending to the gastric cardia, para-aortic lymphadenopathy, and multiple hepatic lesions radiologically consistent with metastases. Histopathology showed invasive high-grade carcinoma with pseudo-signet ring morphology; mucin staining was negative, and immunohistochemistry supported high-grade ESCC (p40 positive; CK7 and CEA negative). Laboratory testing revealed severe pancytopenia (white blood cell count approximately 0.6 × 10⁹/L, hemoglobin 6.9 g/dL, and platelets approximately 55 × 10⁹/L) with markedly elevated lactate dehydrogenase. Bone marrow evaluation and flow cytometry identified approximately 46% myeloid blasts expressing CD117, CD34, CD33, CD13, myeloperoxidase, HLA-DR, and dim CD25, with aberrant CD7 expression in 31% of cells, establishing the diagnosis of AML. A feeding jejunostomy was placed for nutritional support, and the patient was referred for multidisciplinary management.

Severe or unexplained cytopenias in patients with esophageal malignancy warrant prompt hematologic evaluation, including bone marrow examination, to exclude a concomitant myeloid neoplasm and guide individualized treatment sequencing.

Synchronous metastatic ESCC and AML require early multidisciplinary assessment to avoid diagnostic delay and optimize supportive and disease-directed care.