IS Case 192: Metastatic esophageal adenocarcinoma
Imaging Sciences URMC 2008
Publication Date: 2009-05-22
A 55-year-old male presented with a palpable defect in the posterior aspect of the head.
Metastatic esophageal adenocarcinoma
Esophageal adenocarcinoma comprises about half of all forms of esophageal cancers. Over 90% of esophageal adenocarcinomas arise from Barrett's esophagus. Early cancers measure less than 3.5cm and are best evaluated via double-contrast esophagraphy, endoscopic gastroduodenoscopy, and endoscopic ultrasonography. Classic imaging features include immobile, irregular narrowing by a flap or polypoid mass in the lower- to mid-third of the esophagus. CT and/or PET are mainly used for staging advanced cases and metastatic disease. PET is more sensitive for distant metastases than CT alone (69% versus 46%) .
Metastases are detected in 18% of patients with newly diagnosed esophageal adenocarcinoma . The most common site for metastasis includes lymph nodes, liver, and lung. Bone metastases are found in 9% of patients, while brain metastases occur in 2% of cases . Metastatic esophageal adenocarcinoma lesions involving the cranium are unusual [3, 4]. Involvement of the temporal bone may lead to facial nerve paralysis .
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- Weiss MD, Kattah JC, Jones R, Manz HJ. Isolated facial nerve palsy from metastasis to the temporal bone: report of two cases and a review of the literature. Am J Clin Oncol. 1997 Feb;20(1):19-23. [PMID: 9020282]