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The case report describes a four-year course of esophageal cancer with a P53-positive mutation and atypical distant metastases to cardiac and skeletal muscles. Multimodal management, including immunotherapy, is discussed as a possible contributor to prolonged survival. ctDNA remained positive despite negative scans and better predicted recurrence. The article calls for cost-effective screening and standardized treatments.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-uncharted-territories-of-esophageal-cancer-with-cardiac-and-skeletal-muscle-metastasis-a-case-report-and-literature-review/339798/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-uncharted-territories-of-esophageal-cancer-with-cardiac-and-skeletal-muscle-metastasis-a-case-report-and-literature-review/339798.png","ImageObject",300,407,{"name":92,"@type":93},"Oliver","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-25","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What makes the metastasis pattern in this esophageal cancer case unusual?","Question",{"text":112,"@type":113},"The report describes atypical distant metastasis to the cardiac and skeletal muscles, which is rare for esophageal cancer given its anatomy and plexus patterns.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the patient evaluated and staged initially?",{"text":117,"@type":113},"An EDG and imaging workup were performed; an initial PET/CT showed an esophageal mass without evidence of metastatic disease, and the clinical stage was not fully known based on available EGD/EUS data.",{"name":119,"@type":110,"acceptedAnswer":120},"What biomarkers and tests helped predict recurrence in the case?",{"text":121,"@type":113},"ctDNA (circulating tumor DNA) stayed positive despite negative scans and was presented as a better predictor of recurrence in this case. 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The Uncharted Territories of Esophageal Cancer with Cardiac and Skeletal Muscle Metastasis: A Case Report and Literature Review. Medicina 2024, 60, 1146. [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)medicina60071146  \nAcademic Editors: Paola Antonini and Almantas Maleckas  \nReceived: 30 May 2024  \nRevised: 28 June 2024  \nAccepted: 10 July 2024  \nPublished: 16 July 2024  \nCopyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) .  \n1 Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA  \n2 Burroughs Wellcome Fund Fellow, Texas A&M Academy of Physician Scientists, Houston TX 77030, USA  \n3 Department of General Surgery, Swedish Medical Center, Englewood, CO 80113, USA  \n4 Section of GI Oncology, Department of Medical Oncology, Houston Methodist Neal Cancer Center, Houston, TX 77429, USA  \n* [Correspondence: mabdelrahim@houstonmethodist.org](Correspondence: mabdelrahim@houstonmethodist.org)  \nAbstract: Background: Esophageal cancer (EC) comprises 1% of all diagnosed cancers in the USA. It is more common in other parts of the world. If there is distant metastasis, the relative survival rate is 6% . There are no standardized screening methods for EC. Case Presentation: We reported a four-year case of esophageal cancer, a P53-positive mutation with atypical distant metastasis to the cardiac and skeletal muscles. The patient was managed with multimodal therapy, including immunotherapy, which could have been a factor in prolonged survival. Conclusions: Distant metastases are typically seen postmortem, and with prolonged survival, we are able to find such unique metastases antemortem. Despite a history of negative scans, the patient’s ctDNA (circulating tumor DNA) remained positive, which was a better predictor of recurrence in this case. Future research is required to establish cost-effective screening methods and standardized treatments.  \nKeywords: esophageal cancer; immunotherapy; distant metastasis; check point inhibitors; ctDNA  \n1. Introduction  \nEsophageal cancer (EC) is the sixth most common cause of cancer death worldwide [1] . It is more prevalent among males than females and makes up about 1% of all cancers in the USA. The lifetime risk of EC in the USA is 1:125 in men and about 1:417 in women [2] . It is more common in White people, and the associated subtype is adenocarcinoma. However, the most common histological subtype worldwide is squamous cell carcinoma (SCC) . EC is an aggressive cancer usually diagnosed at advanced stages at presentations [3] . To this date, we do not have established screening guidelines for EC. Moreover, noninvasive diagnostic and surveillance tools such as ctDNA, which could provide a snapshot of tumor activity before solid tumor formation, are not well studied for EC. The common sites of metastasis of EC include lymph nodes, lungs, liver, adrenals, bones, and brain. Unexpected metastasis sites are rare in EC due to its unique anatomy and complex plexuses. Chemo-immunotherapy remains the standard of care for advanced stages of EC.  \n2. Case Presentation  \nA 70-year-old female with a past medical history of obesity s/p gastric banding presented to the clinic in 2019 due to a one-month history of nausea and vomiting followed by difficulty swallowing and feeling as though her esophagus was “swollen” General surgery evaluated the patient to have her gastric bands removed.","cbCaieef7oEP6pD2","https://ap.wps.com/l/cbCaieef7oEP6pD2","pdf",1981109,"English","# Abstract\n# 1. Introduction\n# 2. Case Presentation","[{\"question\":\"What makes the metastasis pattern in this esophageal cancer case unusual?\",\"answer\":\"The report describes atypical distant metastasis to the cardiac and skeletal muscles, which is rare for esophageal cancer given its anatomy and plexus patterns.\"},{\"question\":\"How was the patient evaluated and staged initially?\",\"answer\":\"An EDG and imaging workup were performed; an initial PET/CT showed an esophageal mass without evidence of metastatic disease, and the clinical stage was not fully known based on available EGD/EUS data.\"},{\"question\":\"What biomarkers and tests helped predict recurrence in the case?\",\"answer\":\"ctDNA (circulating tumor DNA) stayed positive despite negative scans and was presented as a better predictor of recurrence in this case. NGS showed a P53 mutation.\"}]","The Uncharted Territories of Esophageal Cancer with Cardiac and Skeletal Muscle Metastasis - A Case Report and Literature Review | PDF",1790032286,18]