{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T05:09:04Z","timestamp":1778476144760,"version":"3.51.4"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intramural metastasis from adenocarcinoma of the esophagogastric junction (AEG) to the esophagus is a rare event and is associated with a poor prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary and literature review<\/jats:title>\n                    <jats:p>We 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Esophageal intramural metastasis from AEG is a rare but aggressive metastatic pattern. Its detection warrants prompt recognition and a multidisciplinary, individualized treatment strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1792292","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:24:13Z","timestamp":1778473453000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Esophageal intramural metastasis from adenocarcinoma of esophagogastric junction: a case report and literature review"],"prefix":"10.3389","volume":"16","author":[{"given":"Yongfen","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Zibo Central Hospital","place":["Zibo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen-Wei","family":"Pu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Zibo Central Hospital","place":["Zibo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Pathology, Zibo Central Hospital","place":["Zibo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyu","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pathology, Zibo Central Hospital","place":["Zibo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingmei","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Zibo Central Hospital","place":["Zibo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33210","article-title":"Diagnosis of digestive system tumours","volume":"148","author":"Washington","year":"2021","journal-title":"Int J Cancer"},{"key":"B2","doi-asserted-by":"publisher","first-page":"393","DOI":"10.6004\/jnccn.2023.0019","article-title":"Esophageal and esophagogastric junction cancers, version 2.2023, NCCN clinical practice guidelines in oncology","volume":"21","author":"Ajani","year":"2023","journal-title":"J Natl Compr Canc Netw"},{"key":"B3","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s13045-025-01698-y","article-title":"The current landscape of gastric cancer and gastroesophageal junction cancer diagnosis and treatment in China: a comprehensive nationwide cohort analysis","volume":"18","author":"Chen","year":"2025","journal-title":"J Hematol Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/00003072-200011000-00005","article-title":"Whole-body FDG positron emission tomographic imaging for staging esophageal cancer comparison with computed tomography","volume":"25","author":"Meltzer","year":"2000","journal-title":"Clin Nucl Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2020.02.003","article-title":"Esophagus and gastrointestinal junction tumors","volume":"100","author":"KurTom","year":"2020","journal-title":"Surg Clin North Am"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2019.37.15_suppl.4017","article-title":"S-1 plus oxaliplatin versus S-1 plus cisplatin as first-line treatment for advanced diffuse-type or mixed-type gastric\/gastroesophageal junction adenocarcinoma: a randomized, phase 3 trial","volume":"37","author":"Xu","year":"2019","journal-title":"J Clin Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn441530-20221206-00508","article-title":"Skip metastasis at the esophageal resection margin in radical gastrectomy: clinical characteristics of 30 cases","volume":"26","author":"Liu","year":"2023","journal-title":"Zhonghua Wei Chang Wai Ke Za Zhi"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.14309\/crj.0000000000000869","article-title":"Midesophageal metastatic disease after treatment of gastroesophageal junction adenocarcinoma","volume":"9","author":"Brotherton","year":"2022","journal-title":"ACG Case Rep J"},{"key":"B9","article-title":"A case of esophagogastric junction adenocarcinoma with multiple esophageal intramural metastases","volume":"45","author":"Akamaru","year":"2018","journal-title":"Gan To Kagaku Ryoho"},{"key":"B10","article-title":"A case of esophago-gastric junctional carcinoma with intramural invasion and cervical lymph node metastasis","volume":"44","author":"Hiramoto","year":"2017","journal-title":"Gan To Kagaku Ryoho"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-25294","article-title":"Esophageal intramural metastasis from adenocarcinoma of the gastroesophageal junction","volume":"34","author":"Sz\u00e1nt\u00f3","year":"2002","journal-title":"Endoscopy"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s005950050304","article-title":"Esophageal intramural metastasis from an adenocarcinoma of the gastric cardia: report of a case","volume":"28","author":"Hirota","year":"1998","journal-title":"Surg Today"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjag073","article-title":"Conversion surgery after chemoimmunotherapy for esophageal squamous cell carcinoma with gastric intramural metastasis: a case report and the literature review","volume":"2026","author":"Kitano","year":"2026","journal-title":"J Surg Case Rep"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.4251\/wjgo.v17.i8.110206","article-title":"Challenges in the diagnosis of esophageal cancer with intramural gastric metastasis: two case reports","volume":"17","author":"Wang","year":"2025","journal-title":"World J Gastrointestinal Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2007.12.002","article-title":"Intramural gastric metastasis from recurrent squamous cell carcinoma esophagus masquerading gastrointestinal stromal tumor","volume":"45","author":"Archit","year":"2024","journal-title":"Trop Gastroenterol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.03229.x","article-title":"The changing incidence of oesophageal and gastric adenocarcinoma by anatomic sub-site","volume":"25","author":"Crane","year":"2007","journal-title":"Aliment Pharmacol Ther"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.soc.2006.07.014","article-title":"Epidemiology of adenocarcinoma of the esophagogastric junction","volume":"15","author":"Keeney","year":"2006","journal-title":"Surg Oncol Clin N Am"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0223284","article-title":"Characteristics of proximal early gastric cancer differentiating distal early gastric cancer","volume":"14","author":"Koh","year":"2019","journal-title":"PloS One"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.4103\/JMU.JMU_1_21","article-title":"Intramural gastric metastasis: a rare presentation of esophageal squamous cell carcinoma","volume":"30","author":"Roul","year":"2022","journal-title":"J Med Ultrasound"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.5833\/jjgs.26.1193","article-title":"Clinicopathologic study on intramural lymphatic flow of esophageal carcinoma","volume":"26","author":"Shima","year":"1993","journal-title":"Jpn J Gastroenterol Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1002\/ijc.2910500111","article-title":"Intramural metastasis of thoracic esophageal carcinoma","volume":"50","author":"Kato","year":"1992","journal-title":"Int J Cancer"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2147\/cmar.s182436","article-title":"Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer","volume":"10","author":"Wang","year":"2018","journal-title":"Cancer Manag Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1002\/ijc.29688","article-title":"Age-specific risk factor profiles of adenocarcinomas of the esophagus: a pooled analysis from the international BEACON consortium","volume":"138","author":"Drahos","year":"2016","journal-title":"Int J Cancer"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01234.x","article-title":"Subsite-specific risk factors for esophageal and gastric adenocarcinoma","volume":"102","author":"Crane","year":"2007","journal-title":"Am J Gastroenterol"},{"key":"B25","article-title":"Insights into resection for esophageal adenocarcinoma","volume":"20","author":"Poppers","year":"2024","journal-title":"Gastroenterol Hepatol (N Y)"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.4137\/cgast.s40605","article-title":"Primary esophageal intramural squamous cell carcinoma masquerading as a submucosal tumor: a rare presentation of a common disease","volume":"9","author":"Sonthalia","year":"2016","journal-title":"Clin Med Insights Gastroenterol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13193083","article-title":"FDG PET\/CT and endoscopic ultrasound for preoperative T-staging of esophageal squamous cell carcinoma","volume":"13","author":"Huang","year":"2023","journal-title":"Diagnostics (Basel Switzerland)"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1005575","article-title":"Ultrasonographic detection of lymph-node metastases in superficial carcinoma of the esophagus","volume":"28","author":"Natsugoe","year":"1996","journal-title":"Endoscopy"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1067\/mge.2001.112741","article-title":"Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma","volume":"53","author":"Vazquez-Sequeiros","year":"2001","journal-title":"Gastrointest Endosc"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i23.3699","article-title":"Esophageal mucosal metastasis from adenocarcinoma of the distal stomach","volume":"19","author":"Ki","year":"2013","journal-title":"World J Gastroenterol"},{"key":"B31","article-title":"Esophageal implantation metastasis from adenocarcinoma of the cardia","volume":"54","author":"Sz\u00e1nt\u00f3","year":"2001","journal-title":"Magy Seb"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-022-06839-9","article-title":"Comparison of the clinicopathological characteristics and prognosis of esophageal squamous cell carcinoma with intramural metastases and multiple primary carcinomas","volume":"47","author":"Cheng","year":"2023","journal-title":"World J Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1002\/path.6010","article-title":"Molecular characteristics of multifocal esophageal squamous cell carcinomas to discriminate multicentric origin from intramural metastasis","volume":"258","author":"Li","year":"2022","journal-title":"J Pathol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/01.sla.0000255563.65157.d2","article-title":"Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome","volume":"246","author":"Barbour","year":"2007","journal-title":"Ann Surg"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.49.2.124","article-title":"Measurement of extent of spread of oesophageal squamous carcinoma by serial sectioning","volume":"49","author":"Lam","year":"1996","journal-title":"J Clin Pathol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1007\/s002689900006","article-title":"Intramural metastases from thoracic esophageal cancer: local indicators of advanced disease","volume":"20","author":"Nishimaki","year":"1996","journal-title":"World J Surg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.jtho.2016.10.016","article-title":"Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer","volume":"12","author":"Rice","year":"2017","journal-title":"J Thorac Oncol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(94)91635-7","article-title":"Evolution of treatment strategies for adenocarcinoma of the esophagus and gastroesophageal junction","volume":"58","author":"Wright","year":"1994","journal-title":"Ann Thorac Surg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1792292\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:24:22Z","timestamp":1778473462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1792292\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":38,"alternative-id":["10.3389\/fonc.2026.1792292"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1792292","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]},"article-number":"1792292"}}