SHM Converge Scientific Abstract ePoster Gallery-Upper Gastrointestinal Adenocarcinoma Presenting as a Solitary Cervical Neck Mass

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A 65-year-old man with end-stage renal disease on dialysis, coronary artery disease, heart failure, hypertension, and prior cervical spine decompression presented with six months of melena, dysphagia, weight loss, dysphonia, and torticollis. In the emergency department, he developed acute hypoxic respiratory failure with stridor and required intubation. Exam showed cachexia and a palpable right cervical neck mass.<br /><br />Workup was unexpected. CT of the chest, abdomen, and pelvis showed no malignancy. CT of the neck revealed a large multilobulated right cervical mass causing deviation of the larynx and trachea. Core biopsy of the neck mass demonstrated adenocarcinoma infiltrating skeletal muscle, with an immunohistochemical profile most consistent with an upper gastrointestinal origin. However, EGD showed only three nonbleeding gastric ulcers, and biopsies from the stomach and duodenum were negative for malignancy, including negative staining for epithelial markers and H. pylori. Direct laryngoscopy and bronchoscopy also found no primary head, neck, or airway malignancy.<br /><br />The case is notable because upper gastrointestinal adenocarcinoma typically presents with a visible primary lesion or metastatic disease elsewhere, often involving the left supraclavicular node. Here, the patient had a solitary right cervical neck mass with no identifiable gastrointestinal primary on endoscopy or imaging. This makes the presentation highly unusual and emphasizes that upper GI adenocarcinoma should remain on the differential for cervical neck masses even when GI studies are unrevealing.<br /><br />The patient was discharged with oncology and radiation follow-up but returned in respiratory distress, chose hospice, and later died.

Asset Subtitle

Jason M. Lucas

Meta Tag

Author List Hila Calev, Jason M. Lucas, Jessica Barnes, Samantha Goldstein

Category Clinical Vignettes

Concept Neck Mass

Concept Upper Gastrointestinal Adenocarcinoma

Concept Cervical Lymphadenopathy

Concept Metastatic Disease

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Jason M. Lucas

Track Adult

Keywords

upper gastrointestinal adenocarcinoma

cervical neck mass

metastatic adenocarcinoma

dysphagia

melena

stridor

end-stage renal disease

dialysis

immunohistochemistry

gastric ulcers

Neck Mass

Upper Gastrointestinal Adenocarcinoma

Cervical Lymphadenopathy

Metastatic Disease

Biopsy