Esophageal Cancer - Case #5

A 57 year old male patient initially presented to his primary care physician with a history of dysphagia and difficulty in swallowing. Subsequent evaluation including laparoscopy, biopsy, bronchoscopy and esophagogastroduodenoscopy showed that the patient had a mass at the gastroesophageal junction. The patient underwent a transhiatal esophagogastrectomy for carcinoma.

Imaging Findings:
There was a focal area of very intense increased uptake of FDG in the left subclavicular or subpectoral area corresponding to an area of subcentimeter lymph node in that area. There was an area of moderately increased uptake of FDG in the posterior portion of the esophagus at the mid thoracic level. There were multiple foci of moderate to intense increased uptake of FDG in the aortocaval, mesenteric, peripancreatic, and portocaval areas corresponding to nodes in those areas. There was a large area of intense increased uptake with central photopenia in the right lobe of the liver corresponding to a large low density liver lesion.

Discussion:

This patient had surgical resection for his initial esophageal cancer. Follow-up after the initial resection with multimodality imaging demonstrated metastatic disease, but the combined PEToCT scan elicited a number of additional small metastatic lesions that were not seen on CT alone. This patient was subsequently managed with chemotherapy and is one of the few patients with esophageal cancer who actually had a good long-term response to chemotherapy.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center