case_images: PMC11827132_01
case_images: A, B Coronal CT images of the right lower extremity with IV contrast showing significant abnormal hypodensities within the right gastrocnemius muscle representing myonecrosis (stars)
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case_images: PMC11827132_01_12957_2025_3696_Fig1_HTML.jpg
case_images: Fig1
case_images: A CT scan was ordered and showed significant hypodensity within the muscles of the right lower extremity consistent with myonecrosis (Fig. 1).
case_images: Biopsy of skeletal muscle excised during surgical fasciotomy (A) Hematoxylin and eosin staining at 200x magnification showing atypical poorly differentiated glandular cells with hyperchromatic nuclei, prominent nucleoli, and cystic formations. B CK7 immunohistochemistry staining of the same muscle biopsy at 100x magnification, this marker is expressed in adenocarcinoma of lung, breast, thyroid, endometrium, cervix, ovary, salivary gland, upper GI tract (C) Pancytokeratin immunohistochemistry staining of muscle biopsy at 100x magnification
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case_images: Fig2
case_images: Pathological analysis of the muscle biopsy yielded poorly differentiated non-small cell adenocarcinoma with mucinous features and focal signet ring morphology that stained positive for Pancytokeratin, CK7, and CDX2 on immunohistochemistry (Fig. 2).
case_images: CT images of the chest/abdomen/pelvis with IV and oral contrast (A) Transverse section showing abnormal thickening of the distal esophagus (arrow). B Sagittal section showing abnormal thickening of the distal esophagus at the gastroesophageal junction (arrowhead)
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case_images: Fig3
case_images: This revealed extensive supraclavicular, mediastinal, gastrohepatic ligamentous, and retroperitoneal lymphadenopathy, as well as a marked thickening of the distal esophagus and GE junction extending into the gastric cardia (Fig. 3).
case_images: Upper esophagogastroduodenoscopy image of the distal esophagus near the gastroesophageal junction showing an asymmetric, lobulated mass with uneven, poorly defined borders protruding into the esophageal lumen, with areas of ulceration and surrounding tissue thickening
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case_images: Fig4
case_images: Gastroenterology was consulted, and a diagnostic EGD was performed, showing a large partially obstructing exophytic mass in the distal esophagus expanding into the GE junction through the cardia, fundus, and greater curvature of the stomach (Fig. 4).