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Rare Recurrence of Esophageal Cancer as Bone Marrow Carcinomatosis Leading to Bone Marrow Failure and DIC

Jasmine L. Martin, Warren Brenner

Abstract


Introduction: Esophageal cancer portends a poor prognosis due to high risk of recurrence, even following treatment with curative intent. Recurrence often occurs as distant metastasis, commonly in liver, lung, bone and brain with bone marrow metastasis being infrequently cited in medical literature. Herein we describe a case of bone marrow metastasis of an esophageal primary following resection.

Case presentation: A 78 year-old male with locally advanced GEJ cancer who underwent chemotherapy followed by surgical resection with complete pathological response presented 6 weeks later with right lower quadrant pain. He was found to have hemorrhage in right perinephric space secondary to a ruptured kidney cyst with labs suggestive of DIC and hemolytic anemia. Patient was transfused multiple units of FFP, cryoprecipitate, and blood and ultimately required coil embolization of the right renal artery. The patient was discharged home after prolonged hospital course, and was found to have persistent pancytopenia with hypofibrinoginemia. Bone marrow aspirate and biopsy were performed, which revealed a necrotic marrow replaced with signet ring adenocarcinoma consistent with his esophageal primary. Patient requested hospice care and died six weeks later.

Conclusion: Recurrence of esophageal cancer is common and can occur locoregionally or as distant metastasis, however bone marrow as a site of metastatic spread occurs infrequently. Esophageal cancer recurs typically within two years of resection, therefore follow up and surveillance is a vital component of management, keeping in mind that bone marrow is a possible though atypical site of recurrence.


Keywords


Bone marrow carcinomatosis; metastatic esophageal cancer; adenocarcinoma; DIC

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References


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