An exceptional localization of esophageal cancer: metastasis to the internal auditory canal.

Metastasis to the internal auditory canal (IAC) is rare, representing less than 1% of lesions in this region. We report the case of a 76-year-old man with a history of esophageal adenocarcinoma treated with chemoradiotherapy, who presented with progressive dizziness and unilateral hearing loss. Days later, he developed acute left peripheral facial paralysis. Magnetic resonance imaging revealed an enhancing IAC lesion associated with two cerebellar nodules. Vestibular testing confirmed a complete unilateral deficit. Positron emission tomography (PET) imaging showed hypermetabolic activity in all lesions, and a stereotactic biopsy of the largest cerebellar nodule confirmed the diagnosis of metastatic adenocarcinoma consistent with the esophageal primary. Despite supportive care, the patient died within one month. This case highlights the need to consider metastatic disease in atypical audiovestibular presentations in patients with a cancer history.