Case Author(s): Ed Grishaw, M.D. and Farrokh Dehdashti, M.D. , 08/02/96 . Rating: #D3, #Q4

Diagnosis: Esophageal carcinoma metastatic to the liver and lymph nodes.

Brief history:

52-year old man with upper gastrointestinal bleeding.


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Full history/Diagnosis is available below

Diagnosis: Esophageal carcinoma metastatic to the liver and lymph nodes.

Full history:

52-year old man with upper gastrointestinal bleeding. Subsequent CT scan of the chest and upper abdomen demonstrated an ulcerated esophageal mass extending from the mid thoracic esophagus to the gastroesophageal junction. Biopsy of the mass revealed a mildly differentiated adenocarcinoma.


16.4 mCi F-18 fluorodeoxyglucose i.v.


The PET images demonstrate marked heterogeneously increased FDG accumulation beginning just distal to the hila extending to the gastroesophageal junction There is possible involvement of the gastric cardia . Focal, nodular increased FDG accumulation is seen in the region of the gastrohepatic ligament and celiac axis corresponding to the adenopathy identified on computed tomography . In addition, a small focus of hypermetabolism is identified in the right lobe of the liver (segment 5), compatible with a metastatic lesion. No corresponding abnormality can be identified on computed tomography.


Malignant esophageal lesions outnumber benign tumors by more than four to one. The majority of malignant esophageal tumors are squamous cell carcinomas; occasional examples of primary esophageal adenocarcinoma, carcinosarcoma, lymphoma, sarcoma, and melanoma. have been described At the time of diagnosis, neoplastic burden is usually advanced with the overall five-year survival rate between 4% and 10% despite more aggressive surgical and radiation therapies. Direct contiguous and lymphatic spread can be rapid because of the lack of an esophageal serosa.

References: Moss AA, Gamsu G, Genant HK. Computed tomography of the body with magnetic resonance imaging: Volume 3, Abdomen and Pelvis. W.B. Saunders Co., 1992; pp 649-659.

Flanagan FL, Dehdashti F, Siegel BA, Trask DD, Sundaresan SR, Patterson GA, Cooper JD. Staging of esophageal cancer with FDG-PET. AJR 1997: 168:417-424.

Major teaching point(s):

This case illustrates the utility of PET in the pretreatment planning of esophageal carcinoma. Its utility not only lies in its ability to detect the extent of theprimary lesion, but also areas of metastatic disease, which in some cases may be subradiographic.

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Gasterointestinal System, Category:Neoplasm, Neoplastic-like condition)

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Case number: pt012

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