Squamous cell carcinoma of esophagus presenting as bone metastases in five cases

Introduction: Esophageal carcinoma rarely metastasizes to the bone. The objective of the current study was to report five cases of esophageal carcinoma whieh first presented with bone metastases.
Material and Methods: From January 1987 to June 2001, 550 patients with esophagealcancer were admitted to the Department Radiology of Ghaem Hospital for barium swallow, CT scan, sonography and plain radiographs. In five patients (three men, two women) first symptoms were bone pain and swelling due to metastasis. Radiographs and CT scan of specific bones were taken for diagnosis. Biopsy confirmed the diagnosis of squamous cell carcinoma metastases to bone. The primary site of malignancy was unknown at the time of presentation. Further evaluation including barium swallow, proved squamous cell carcinoma of esophagus that metatastasized to the bones.
Results: Five patients with esophageal carcinoma (age range, 24–60 years; mean age,45 years) Two patients showed solitary metastasis, and three patients had multiple metastases. Pelvis, cervical vertebrae, ribs, tibia and femur were involved. Patterns of bony destruction were lytic and in one patient was mixed (osteolytic-osteosclerotic). Two patients had cortical metastases simulating a primary bone tumor. The mean interval between skeletal metastasis and the appearance of dysphagia was two months.
Conclusion: Bone metastases are very uncommon at initial presentation in patients with esophageal carcinoma, but Patterns of bony destruction in esophageal carcinoma were predominatly lytic and rarely sclerotic.