Esophageal Metastases and Lymphoma

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 19/07/2015

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 Dysphagia, weight loss, hematemesis, or asymptomatic

• Esophageal metastases

image Direct, lymphatic, or hematogenous spread
image Direct invasion most common route: Gastric and lung cancer most common primary tumors
• Complications

image GI bleeding, perforation, obstruction
• Treatment

image Chemotherapy; radiation therapy
image Surgical resection of complicating lesions (obstruction, upper GI bleed)
image Endoluminal stent for obstructing lesions
• Prognosis

image Usually poor

DIAGNOSTIC CHECKLIST

• Check for history of primary extraesophageal cancer; biopsy required
• Overlapping radiographic features of esophageal metastases, lymphoma, and primary carcinoma
image
(Left) In this 60-year-old woman with lung cancer and progressive dysphagia, 2 views from an esophagram show extrinsic or intramural narrowing of the mid esophagus image, but intact mucosal folds, representing invasion by her lung cancer.

image
(Right) Esophagram in a man with known lung cancer and dysphagia shows a broad shelf-like indentation image along the anterior wall of the mid esophagus.
image
(Left) In this 62-year-old man, a spot film of the distal esophagus shows a distal stricture and mucosal irregularity image that mimics primary esophageal cancer. However, other views (not shown) showed nodular thickened folds in the gastric fundus.

image
(Right) CT in the same patient shows a mass image within the wall of the fundus with extension into the perigastric tissues and nodes. Endoscopy confirmed a primary gastric carcinoma.

TERMINOLOGY

Definitions

• Metastases from primary cancer of other sites
• Lymphoma: Malignant tumor of lymphocytes

IMAGING

General Features

• Best diagnostic clue

image From gastric cancer: Ulcerated/polypoid mass of gastric cardia extending into distal esophagus
image From lung cancer: Extrinsic indentation of upper esophagus from primary cancer or malignant adenopathy

Radiographic Findings

• Fluoroscopic-guided double-contrast barium study

image Direct invasion, gastric carcinoma: Distal esophagus

– Ulcerated/polypoid mass of cardia/fundus
– Irregular or smooth, tapered narrowing of distal esophagus ± discrete mass
image Direct invasion of cancer of larynx, pharynx, thyroid, lung: Cervical or thoracic esophagus

– Smooth or slightly irregular esophageal wall, soft tissue mass in adjacent neck/mediastinum
– 

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