Introduction

Oesophageal carcinoma is the sixth most common cancer in the world, most commonly affects mid  to late adulthood. Only 5–10% patients who diagnosed survive for five years, rest of the patients die in the due course of the disease. the most common pattern of esophageal cancer metastasis (ECM)  is to the lymphnode, lung, liver , boones , adrenal gland and the brain. Sometimes unexpected distant metastasis also occur to unusal sites other then expected that is skeletal muscle in our case.

CASE REPORT

We present a case of oesophageal carcinoma in a elderly gentleman with distant skeletal metastasis –a very rare delayed presentation of oesophageal carcinoma, & discuss about the various presentation and diagnostic modelities and the treatment options, with literature review.

In this case report we presented a case of oesphageal carcinoma who treated initially with three field oesophegectomy and with adjuvant chemoradaition. Later on in routine follow–up patient presented with hemetmesis, and on PET–SCAN incidental finding was an nodule in theright thigh suspecting of sarcoma–a new primary or a distant metastasis from the primary oesphageal carcinoma that later on turned out into metastatic adenocarcinoma from the primary oesophageal carcinoma. By doing through study and review of literature of more then 1000 pub med cases only 7–8 cases till date are reported for oesophageal carcinoma with distant metastasis to skeletal muscle, our case is very unique one in presentation, as none of the 7–8 reported cases , presented with delayed skeletal muscle(in our case almost after 3 yrs of curing the primary lesion), all are reported at the very initial presentation or with in 4–6 weeks of initial presentation, and probably one of the first case with such presentation(particulary in right thigh muscle).

CONCLUSION

Oesopageal carcinoma mainly present distant metastasis to lymph nodes, lung, liver, bone while SMM represent  a rare presentation in patients with oesophageal carcinoma, the incidence may be increasing because of better diagnostic tool available now a days,  and because of better control of primary, a high clinical suspicion is needed along with PET–CT and histopathoogical examination to diagnose delayed skeletal muscle distant metastasis, an active therapeutic multidisciplinary approach including surgery, radiation and chemotherapy may result in better survival that is longer in comparison to other metastaic esophageal carcinoma cases.