IS Case 192: Metastatic esophageal adenocarcinoma

Daniel Ginat, MD, MS


Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

A 55-year-old male presented with a palpable defect in the posterior aspect of the head.

Findings

Head CT and MRI were performed which revealed a large lytic lesion with a soft-tissue component in the right parietal bone. There was no evidence of dural or parenchymal invasion or involvement.

PET/CT demonstrated increased metabolic activity in the mid-esophagus. Multiple osseous metastases were also evident.

Diagnosis

Metastatic esophageal adenocarcinoma

Discussion

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%) [1].

Metastases are detected in 18% of patients with newly diagnosed esophageal adenocarcinoma [2]. 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 [2]. Metastatic esophageal adenocarcinoma lesions involving the cranium are unusual [3, 4]. Involvement of the temporal bone may lead to facial nerve paralysis [4].

References

  1. Luketich JD, Friedman DM, Weigel TL, et al. Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg. 1999 Oct;68(4):1133-6; discussion 1136-7. [PMID: 10543468]
  2. Quint LE, Hepburn LM, Francis IR, Whyte RI, Orringer MB. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer. 1995 Oct 1;76(7):1120-5. [PMID: 8630886]
  3. Tideman H, Arvier JF, Bosanquet AG, Wilson DF. Esophageal adenocarcinoma metastatic to the maxilla. Oral Surg Oral Med Oral Pathol. 1986 Nov;62(5):564-8. [PMID: 3466129]
  4. 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]

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