Case report and literature review on oxaliplatin and tegafur for AEG with intramural metastasisA rare cancer spread inside the esophagus wall needs careful treatment plans for older adults

BackgroundIntramural metastasis from adenocarcinoma of the esophagogastric junction (AEG) to the esophagus is a rare event and is associated with a poor prognosis.Case summary and literature reviewWe report a 77-year-old male patient diagnosed with AEG with esophageal intramural metastasis. Upper gastrointestinal endoscopy revealed an infiltrative ulcerative tumor at the esophagogastric junction and a submucosal protrusion in the middle esophagus. Biopsies from both lesions confirmed moderately to poorly differentiated adenocarcinoma. The patient received seven cycles of neoadjuvant chemotherapy (oxaliplatin and tegafur), followed by lower esophagectomy and total gastrectomy. Postoperative radiotherapy was administered for residual esophageal metastasis. Although the patient initially improved, he died approximately three years after surgery. A systematic search of PubMed, Embase, and Web of Science identified six relevant articles on esophageal intramural metastasis from AEG. The findings suggest that tumor cells primarily spread through venous and lymphatic channels within the esophageal wall. The presence of intramural metastasis on endoscopy indicates systemic disease and a poor prognosis. An individualized treatment approach, potentially combining neoadjuvant chemotherapy, radiotherapy, immunotherapy, and surgery, may offer the best outcome.ConclusionEsophageal intramural metastasis from AEG is a rare but aggressive metastatic pattern. Its detection warrants prompt recognition and a multidisciplinary, individualized treatment strategy.