case_images: PMC10805548_01
case_images: Clinical presentation of the patient. (a) Patient had extensive erythema along his neck. (b, c) Patient had a submental subcutaneous mass that extended to the midline neck. (d) Patient presented with dilated superficial skin venae.
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case_images: PMC10805548_01_CRIDM2024-7951391.001.jpg
case_images: fig1
case_images: On examination in clinic, there was extensive erythema along his neck, extending for 26 centimeters in a horizontal direction and 10 centimeters in a vertical direction (Figure 1(a)). The erythema and woody feeling of the neck extended another 13 cm right lateral from the main mass (Figures 1(b) and 1(c)). He was noted to have prominent, dilated superficial skin venae and a compressible soft tissue swelling along the right subclavicular area (Figure 1(d)).
case_images: (a) Results from esophagoscopy show a circumferential fungating and ulcerated mass with friable surfaces was found at the gastroesophageal junction. Esophageal biopsy showing poorly differentiated adenocarcinoma, diffuse type. (b) Unremarkable squamous epithelium is shown on the right and the discohesive tumor cells are on the left. (c) Proliferation of signet ring cells (arrow) with intracellular mucin that displaces the nucleus to the side. (d, e) Immunohistochemical staining shows positive staining in highlighting tumor cells in CK (AE1-AE3) and MUC5AC and negative staining of P63, supporting the diagnosis of adenocarcinoma (f).
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case_images: PMC10805548_01_CRIDM2024-7951391.002.jpg
case_images: fig2
case_images: Esophagoscopy results are demonstrated in Figure 2(a). He underwent a core biopsy of his submental mass during this visit (Figure 2(b)). Pathology demonstrated tumor cells with gland-like structures, signet ring cell morphology (Figure 2(c)). Tumor cells were positive for CK7, MUC5AC (Figures 2(d) and 2(e)), CK20, CDX2, and negative for P63 (Figure 2(f)), CK 5/6, HER2, NKX3.1, p40, PSA, SATB2, SOX10, and
case_images: PET/CT scan and MRI of the patient. PET/CT scanning was performed following the intravenous administration of F-18 FDG and intravenous and enteric contrast. F-18 emission and CT attenuation acquisitions were performed, utilizing diagnostic-quality CT. CT FINDINGS: no masses or areas of abnormal enhancement are identified in the head and neck region. No lymphadenopathy is identified. PET FINDINGS: there is hypermetabolic activity in the lower esophagus and GE junction. While this is likely physiologic or inflammatory activity, malignancy is not excluded. MRI results demonstrate extensive expansile infiltrative process representing known metastatic disease involving the right neck and shoulder musculature, particularly the sternocleidomastoid, anterior scalene, and levator scapulae.
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case_images: PMC10805548_01_CRIDM2024-7951391.003.jpg
case_images: fig3
case_images: There was severe narrowing of the right internal jugular vein (Figure 3).