An unusual case of esophageal adenocarcinoma presenting with disseminated intravascular coagulation (DIC) as a result of carcinomatosis of the bone marrow
We describe a rare case of esophageal adenocarcinoma presenting with carcinomatosis of the bone marrow resulting in disseminated intravascular coagulation (DIC). A 73-year-old male presented with fatigue, night sweats, and easy bruising. Laboratory evaluation showed severe anemia, thrombocytopenia, and a coagulopathy consistent with DIC. Bone marrow biopsy demonstrated markedly hypocellular marrow with involvement of metastatic adenocarcinoma. Upper endoscopy revealed a stenotic lesion at the gastroesophageal junction, and biopsies confirmed esophageal adenocarcinoma. Imaging studies showed no evidence of visceral metastases. DIC was attributed to diffuse bone marrow involvement of the primary esophageal cancer. The patient received intensive supportive care for his DIC followed by first-line chemotherapy with 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX). Treatment of the underlying malignancy resulted in stabilization of his DIC. This is the first reported case of esophageal adenocarcinoma with disseminated carcinomatosis of the bone marrow leading to DIC. We also discuss the prevalence and significance of bone marrow micrometastases in esophageal cancers as well as the association and clinical implications of DIC in solid tumor malignancies.