Metastatic esophagogastric cancer

Case contributed by Dr MT Niknejad

Presentation

Work up for chest pain and dysphagia.

Patient Data

Age: 70 years
Gender: Male

Marked circumferential increased wall thickness due to tumoral infiltration is present at the distal half of the esophagus that extends to gastric cardia, subcardia, and proximal of the lesser curvature. There is no sign of local invasion to adjacent structures.

Multiple mediastinal and upper perigastric lymphadenopathy are observed with SAD less than 25 mm. 

A tiny amount of pleural effusion is noted on the right side.

Some abdominopelvic free fluid is present. Several soft tissue density masses at perihepatic regions inferring tumoral seeding.

In addition, several lymphadenopathy is seen at the para aortic region with SAD less than 22 mm.

The liver is enlarged and contains multiple varying sized ill defined low enhancing masses consistent with metastases.

A few nonenhanced simple cortical cysts are seen in both kidneys.

Two masses are seen at right and left adrenal glands measuring 25×21 mm and 26×20 mm, respectively. The density and enhancement pattern of both masses are most compatible with metastasis.

The prostate gland is enlarged. 

Degenerative changes as osteophytosis are seen at the thoracolumbar spine.

Grade I spondylolisthesis of L4 on L5 is present. 

Case Discussion

Esophagogastric cancer; pathology proves adenocarcinoma, mediastinal, perigastric, and para aortic lymphadenopathy, hepatic and adrenal metastases, ascites, peritoneal tumoral deposits, and pleural effusion.

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