|Year : 2017 | Volume
| Issue : 3 | Page : 145-146
Esophageal carcinoma causing cystic metastases of liver
Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India
|Date of Web Publication||7-Dec-2017|
St. John's Medical College, Bengaluru - 560 034, Karnataka
Source of Support: None, Conflict of Interest: None
Esophageal cancer with liver metastasis is rare and when diagnosed is usually advanced and surgical management is contraindicated. The most common sites of distant hematogenous metastases in esophageal cancer cases are the liver, lungs, and bones. Here, we present a rare case of esophageal carcinoma presenting with cystic metastases to the liver.
Keywords: Adenocarcinoma, chemotherapy, cystic metastases, esophageal carcinoma
|How to cite this article:|
Ravikanth R. Esophageal carcinoma causing cystic metastases of liver. Digit Med 2017;3:145-6
| Introduction|| |
Esophageal cancer with concomitant liver metastasis is a rare and lethal disease. Multimodal management including surgery may offer prolonged survival. Synchronous presentation of esophageal cancer with hepatic metastasis is rare, and often the disease is advanced to an extent that surgical curative treatment is not an option. On the other hand, hepatic resection for colorectal metastatic disease is well established, and in selected cases, the hepatic and bowel resections are simultaneously performed.
| Case Report|| |
A 65-year-old woman with a history of dysphagia to solids for 4 months and jaundice, pruritus with dragging pain in the right upper quadrant of abdomen presented to the surgical OPD. On examination, vitals were stable. Epigastric tenderness with gross hepatomegaly was noted on per abdominal palpation. Blood investigations revealed deranged liver function tests. Endoscopy of the upper gastrointestinal tract demonstrated slightly elevated lesion occupying 2/3rd of the circumference at lower third of esophagus. Histopathologic examination of the specimen obtained by endoscopic biopsy revealed poorly differentiated adenocarcinoma. Contrast-enhanced computed tomography thorax with abdomen was performed as part of the imaging workup. Imaging revealed gross hepatomegaly with multiple centrally hypoattenuating lesions with irregularly thickened enhancing walls involving both lobes of liver [Figure 1]. Eccentric wall thickening showing enhancement was noted in the terminal esophagus [Figure 2]. Moderate ascites noted. Further evaluation revealed no other possible sites of metastasis. Systemic chemotherapy with 5-fluorouracil was initiated.
|Figure 1: Axial contrast-enhanced computed tomography image at the level of terminal esophagus showing eccentric wall thickening showing contrast enhancement and luminal narrowing|
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|Figure 2: Axial contrast-enhanced computed tomography image showing multiple centrally hypoattenuating and peripheral wall enhancing lesions involving both lobes of liver suggestive of cystic metastasis|
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| Discussion|| |
The most common sites of distant hematogenous metastases in esophageal cancer cases are the liver, lungs, and bones. CT is the modality of choice for staging distant metastasis. Cystic metastases show enhancing rim component in the arterial phase with hypo-/non-enhancement in portal venous and delayed phases of imaging. Most liver metastases are multiple with both lobes involved. Only in 10% of cases, metastases is solitary. Cystic metastases have been demonstrated in colorectal, esophageal, pancreatic mucinous adenocarcinoma, neuroendocrine tumors, and ovarian carcinoma. CECT and magnetic resonance imaging typically demonstrate multiple lesions with strong enhancement of the peripherally viable and irregularly defined tissue. As the prognosis of esophageal adenocarcinoma with distant metastasis is very poor and the disease spreads aggressively, early detection and rapid treatment are extremely important.
| Conclusion|| |
Esophageal adenocarcinoma is a well-known cause of distant metastasis. It initially tends to spread locally, then metastasizes to the lymph nodes, and finally to the distant organs most commonly liver. Esophageal carcinoma should be considered in the differential diagnosis in a patient with cystic metastasis to the liver. Hepatic metastasis suggests that the disease has advanced to an extent that surgical curative treatment is not an option for esophageal carcinoma. Distant metastases other than those to lymph nodes are relatively more frequent in adenocarcinoma of esophagus.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]