Esophageal adenocarcinoma

Case contributed by Dr Abdallah Al Khateeb

Presentation

Progressive dysphagia and unintentional weight loss.

Patient Data

Age: 60 years
Gender: Male
Fluoroscopy

Fixed irregular and nodular narrowing of the distal esophagus. Small hiatal hernia.

ct
  • circumferential mural thickening of the lower thoracic esophagus
  • loss of fat planes between the esophagus and the proximal left mainstem bronchus and the aorta
  • multiple enlarged mediastinal, lower paraesophageal and left gastric lymph nodes
  • small hypodense right liver lobe lesion

PET-CT

Nuclear medicine
  • lower esophageal wall thickening and corresponding abnormally increased FDG uptake
  • abnormally increased FDG uptake in multiple enlarged mediastinal, paraesophgeal and left gastric nodes, and non-enlarged bilateral para-aortic nodes
  • sigmoid diverticulum with increased uptake
  • no increased uptake in the liver lesion

Case Discussion

Along with this patient's presentation, the findings on the esophagogram, namely the irregular stricture at the lower esophagous, are highly concerning for primary esophageal malignancy. For that, esophagogastroduodenoscopy and tissue biopsy were performed and confirmed esophageal poorly differentiated adenocarcinoma.

Treatment and prognosis largely depend on the tumor stage, which usually requires the combined input of anatomic and functional imaging information.

  • endoscopic ultrasound is key in establishing the T stage
  • CT identifies local extent of the tumor (e.g. as in this case, loss of fat planes with adjacent structures suggests invasion; T4 disease), visceral metastases, and metastatic lymphadenopathy
  • PET-CT primarily helps in determining regional and non-regional nodal status (e.g. in this patient, PET helped identify the metastatic paraaortic nodes)

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