Disclosures: Kush Goyal, MD: No financial relationships or conflicts of interest

Case Diagnosis: Esophageal cancer stage IV

Case Description: A 22-year-old Caucasian healthy male with no reported prior medical history presented with two months of low back pain attributed to a wrestling injury. Initial X ray as an outpatient was read as “Normal lumbar spine”. Three weeks later, he was admitted for intractable back pain and an L2 compression fracture of 10% was seen on repeat x ray. At spine medicine clinic, he noted increased back pain and difficulty walking. Physical examination was notable for bilateral hip flexion weakness and lower extremity hyperreflexia. Advanced imaging: Lumbar MRI and CT showed an 70% compression fracture of L2 with edema on STIR with retropulsion.

Setting: Academic HospitalAssessment/

Results: The case was discussed at the spine tumor board. Biopsy of L2 was recommended, which showed cortical bone with small clusters of highly atypical cells suspicious for malignancy. PET scan revealed a prominent hypermetabolic focus in the distal esophagus and a smaller focus in the left common iliac lymph node. Endoscopic biopsy confirmed esophageal adenocarcinoma. He underwent L2 corpectomy, tumor decompression, L1-L3 expandable cage insertion, and T12-L4 posterior fusion for spine surgical stabilization. Surgical pathology reported poorly differentiated high grade malignant epithelial origin.

Discussion: There are less than five known cases of occult esophageal cancer presenting with spine-related symptoms in the literature. The mean age of esophageal cancer diagnosis is 68 years old, with 0.5% of cases in the United States occurring in patients younger than 30. Esophageal cancer is often asymptomatic until late stage disease; 40% of patients present with distant metastasis at diagnosis. Esophageal cancer is not a category in most spine metastasis studies given its rarity.

Conclusion: The patient’s good health, low risk profile, and atypical presentation make this case extremely unusual, highlighting the potential for rare diseases to masquerade as common conditions in spine-related fields.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spine-metastasis-with-pathologic-compression-fracture-from-esophageal-adenocarcinoma-in-a-22-year-old-male/