Metastatic esophageal cancer
Five months of right upper quadrant pain. Deranged LFTs. Increased pain over three days. US demonstrated liver lesions, for further characterisation.
Triple phase liver
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The liver is enlarged and abnormal. Ill-defined heterogeneity throughout the liver, although predominantly affecting the left lobe. There are multiple hypodense lesions, which are irregular in shape and may represent a confluence of multiple smaller lesions (e.g. segment four b). These demonstrate some peripheral enhancement with portal venous phase filling in but this is inconsistent and no lesions show this pattern (e.g. segment five).
Concentric mural thickening of the distal esophagus, gastro-esophageal junction and cardia.
Adrenal glands, kidneys, pancreas and spleen are normal. Gallbladder is collapsed. Massively enlarged porta hepatis and para-aortic lymph nodes.
The patient proceeded to endoscopic biopsy:
- 140cm oes": Viable tan fragments 3x3x1mm in aggregate. A1.
- "Cardiac": Four fragments 1-2mm. A1.
The biopsies show features of poorly differentiated adenocarcinoma. The tumour forms trabeculae, nests and complex glandular structures. It is surrounded by inflamed stroma. The tumour cells have enlarged hyperchromatic nuclei, prominent nucleoli and moderate amounts of focally vacuolated cytoplasm. There is some mucoid material in the background. No evidence of lymphovascular invasion is seen. A small strip of normal gastric mucosa is present. The tumour cells are diffusely CK20 and CDX-2 positive with very focal CK7 positivity. P504S is negative.
DIAGNOSIS: Poorly differentiated adenocarcinoma.
Esophageal carcinoma is rare in patients under 30 years age.