Rare Extraluminal Esophageal Cancer Invades Spine Despite Normal Endoscopy
News, Oncoscience
May 14, 2026“Esophageal tumors can rarely escape endoscopic detection by growing in atypical patterns, such as entirely outside the esophageal lumen.”
BUFFALO, NY — May 14, 2026 — A new case report was published in Volume 13 of Oncoscience on March 19, 2026, titled “Unprecedented non-luminal esophageal adenocarcinoma invading the spine.”
The study was led by first and corresponding author Benjamin Wenyuan Xie from the University of Louisville School of Medicine. In this report, the authors describe an exceptionally rare presentation of esophageal adenocarcinoma in a 68-year-old man whose cancer grew outside the esophageal lumen and invaded the thoracic spine, despite a previously normal upper endoscopy. The patient initially presented with rapidly worsening lower-extremity weakness, sensory loss, and urinary retention caused by spinal cord compression from a pathological T5 vertebral fracture. He had also experienced several months of progressive dysphagia and substantial weight loss prior to diagnosis.
One month before admission, the patient underwent upper endoscopy with extensive biopsies for evaluation of dysphagia and weight loss. However, the examination revealed only reflux-related changes and a hiatal hernia, with no visible malignancy or Barrett’s esophagus. As shown in Figure 1 of the paper (page 2), the esophageal and gastric mucosa appeared grossly normal during endoscopic inspection.
Subsequent imaging painted a far more serious picture. Contrast-enhanced CT revealed a posterior mediastinal mass contiguous with the esophagus that had destroyed the T5 vertebral body and extended into the spinal canal, causing severe spinal cord compression. Multiple pulmonary nodules and hilar lymphadenopathy also raised concern for metastatic disease. Figure 2 of the report (page 3) illustrates the extensive vertebral destruction and epidural tumor extension associated with the lesion.
“This unprecedented pattern of esophageal adenocarcinoma—growing extraluminally with isolated posterior extension to the spine—highlights the potential for esophageal cancer to present with no mucosal lesion on endoscopy.”
Urgent neurosurgical decompression and spinal stabilization were performed. Histopathologic examination of the epidural tumor demonstrated poorly differentiated adenocarcinoma consistent with an esophageal primary. Immunohistochemical staining showed positivity for CK AE1/AE3 and CK7, with patchy CK20 and CDX-2 expression, supporting upper gastrointestinal origin, while pulmonary markers including TTF-1 and Napsin A were negative.
The authors note that this pattern of isolated posterior invasion is virtually unprecedented in esophageal adenocarcinoma. Advanced esophageal cancers more commonly invade anterior or lateral structures such as the trachea, bronchi, aorta, or pleura. In contrast, this tumor extended almost exclusively into the vertebral column while remaining occult on endoscopy.
Importantly, the report highlights a significant diagnostic challenge in esophageal cancer evaluation. Reliance on mucosal visualization alone may fail to detect rare extraluminal growth patterns, particularly in patients who continue to exhibit high-risk symptoms despite initially benign endoscopic findings. The authors suggest that persistent clinical suspicion should prompt additional evaluation with cross-sectional imaging or endoscopic ultrasound when symptoms remain unexplained.
Overall, this case expands current understanding of how esophageal adenocarcinoma can behave in rare circumstances. By documenting a non-luminal tumor growth pattern with direct spinal invasion and initially negative endoscopy, the report underscores the importance of multidisciplinary evaluation, early imaging in high-risk patients, and continued vigilance when classic warning signs persist despite nondiagnostic initial testing.
DOI: https://doi.org/10.18632/oncoscience.653
Correspondence to: Benjamin Wenyuan Xie – bwxie001@louisville.edu
Keywords: cancer, esophageal adenocarcinoma, atypical esophageal cancer, spinal invasion, non-luminal presentation, normal esophagogastroduodenoscopy
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