PET-CT case of the month (10/09): Esophageal Cancer
This case was compiled by Dr. Sabeen Rahman (BCM)
A 63 years old male with past medical history of CABG presented with a 2-3
week history of dysphagia. He was able to localize a point in the region of
his distal esophagus where solid foods were getting ‘stuck.’ He was able to
drink some liquids but noted that they too were passing with increasing
difficulty. An EGD was performed by GI and a circumferential mass was
seen at the lower end of esophagus. Biopsy showed invasive moderately
differentiated adenocarcinoma. CT scan showed the mass at the distal
esophagus, and lymphadenopathy in the aorto-pulmonary window, adjacent
to the celiac trunk and along the lesser curvature of the stomach. EUS could
not be performed due to luminal narrowing. A whole body PET-CT was
acquired for initial staging and to evaluate for distant metastasis.
week history of dysphagia. He was able to localize a point in the region of
his distal esophagus where solid foods were getting ‘stuck.’ He was able to
drink some liquids but noted that they too were passing with increasing
difficulty. An EGD was performed by GI and a circumferential mass was
seen at the lower end of esophagus. Biopsy showed invasive moderately
differentiated adenocarcinoma. CT scan showed the mass at the distal
esophagus, and lymphadenopathy in the aorto-pulmonary window, adjacent
to the celiac trunk and along the lesser curvature of the stomach. EUS could
not be performed due to luminal narrowing. A whole body PET-CT was
acquired for initial staging and to evaluate for distant metastasis.
Alzheimer’s’ disease or Dementia of Alzheimer’s type (DAT) is strongly
suggested in this patient due to the classic finding of reduction in the
bilateral posterior parieto-temporal regions and sparing of the
sensorimotor cortex. Decreased metabolism in the frontal regions is
suggestive of advanced Alzheimer’s disease.
suggested in this patient due to the classic finding of reduction in the
bilateral posterior parieto-temporal regions and sparing of the
sensorimotor cortex. Decreased metabolism in the frontal regions is
suggestive of advanced Alzheimer’s disease.
PET-CT images show a hypermetabolic lesion in the distal esophagus
consistent with malignancy. Hypermetabolic lymphadenopathy (max SUV
8.3) is seen in the abdomen and thorax, and also in the left supraclavicular
region (Virchow’s node), consistent with metastasis. Multiple small
hypermetabolic lesions are seen in the liver, suspicious for metastasis. A
hypermetabolic and lytic lesion seen in the right ilium, and focal uptake seen
in the left pedicle of T3 are consistent with bone metastasis.
consistent with malignancy. Hypermetabolic lymphadenopathy (max SUV
8.3) is seen in the abdomen and thorax, and also in the left supraclavicular
region (Virchow’s node), consistent with metastasis. Multiple small
hypermetabolic lesions are seen in the liver, suspicious for metastasis. A
hypermetabolic and lytic lesion seen in the right ilium, and focal uptake seen
in the left pedicle of T3 are consistent with bone metastasis.
1. The evolving role of PET-CT in the management of esophageal cancer.
Chuang HH, Macapinlac HA. Q J Nucl Med Mol Imaging. 2009
Apr;53(2):201-9.
2. The role of 18F-FDG PET/CT in the evaluation of oesophageal
carcinoma. Chowdhury FU, Bradley KM, Gleeson FV. Clin Radiol. 2008
Dec;63(12):1297-309.
This case was compiled by Dr. Sania Rahim-Gilani, BCM
Chuang HH, Macapinlac HA. Q J Nucl Med Mol Imaging. 2009
Apr;53(2):201-9.
2. The role of 18F-FDG PET/CT in the evaluation of oesophageal
carcinoma. Chowdhury FU, Bradley KM, Gleeson FV. Clin Radiol. 2008
Dec;63(12):1297-309.
This case was compiled by Dr. Sania Rahim-Gilani, BCM