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Squamous Cell Esophageal Cancer

Payne KSP - MedPix (2007)

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: Squamous Cell Esophageal Cancer

History: 61 y/o male presented with dysphagia x 6 weeks with solid foods. He was able to tolerate some liquid foods. He had modified his diet due to these symptoms. Patient complained of no other symptoms. PMHX: coronary artery disease requiring CABG – 2 vessel, HTN, DM Type I, Hyperlipidemia, chronic esophageal reflux. No history of smoking. +30 year history of alcohol use.

Findings: Barium Esophagram (Not pictured) CONCLUSION: Lower esophageal stricture. This is most concerning for malignancy vs. possible peptic stricture. Recommend GI consult for direct visualization. CT Oncology: IMPRESSION: Findings concerning for distal esophageal carcinoma with regional nodal metastases and possible lung metastases. In particular, the juxtapleural speculated opacity in the left lower lobe may reflect an area of rounded atelectasis, pneumonia, or metastatic focus. Correlate with pending PET scan. PET CT: IMPRESSION: 1. Findings consistent with metabolically active mass in the distal esophagus with a maximum SUV of 13. 2. The left lower lung nodule is metabolically active with a max SUV of 5.1 consistent with metastatic disease. 3. Multiple nodal metastatic disease involving subcarinal lymph node, left infrahilar lymph node and abdominal lymph nodes. 4. Increased metabolic activity present in the left adrenal with a max SUV of 4.6 consistent with metastatic disease.

Ddx: Peptic stricture, achalasia, carcinoma

Dxhow: Pathology – biopsies SPECIMEN: Mass, distal esophagus (Obtained with EGD) CLINICAL DIAGNOSIS AND HISTORY: Dysphagia PRE-OPERATIVE DIAGNOSIS: {None given} POST-OPERATIVE DIAGNOSIS: Operative findings: There was an annular circumferential friable mass present in the esophagus 35.0 to 40.0 cm from the gums. The endoscope could not traverse the lesion and a 6.0 mm pediatric endoscope was then used to complete the exam. The stomach, pylorus, and duodenum appeared normal. GROSS DESCRIPTION: Esophageal mucosal biopsy, submitted are multiple fragments of tan tissue measuring up to 0.2 cm in greatest dimension. FINAL DIAGNOSIS: MASS, DISTAL ESOPHAGUS, MUCOSAL BIOPSY: -- Poorly differentiated carcinoma. (SEE COMMENT) -- Squamous mucosa with acute inflammation, necroinflammatory debris and fungal organisms morphologically consistent with Candida species. -- Actinomyces species identified. Comment: The primary Pathologist favors a squamous cell carcinoma with focal glandular features. SPECIMEN: CORE LUNG BIOPSY CLINICAL DIAGNOSIS AND HISTORY: ESOPHAGEAL CANCER WITH LUNG NODULE, EVAL FOR METS. PRE-OPERATIVE DIAGNOSIS: {None given} GROSS DESCRIPTION: Lung biopsy. Received in formalin are 3 needle biopsies of thin, gray tissue approximately 0.1 cm in diameter and 1.2 cm in length. FINAL DIAGNOSIS: LUNG, NEEDLE BIOPSY: --Poorly differentiated carcinoma. (SEE COMMENT) Comment: The lung tumor and esophageal neoplasm were both stained for cytokeratin 7, cytokeratin 20, and TTF-1. Both lesions have the same profile (cytokeratin 7 positive, cytokeratin 20 positive, TTF-1 negative). The lung lesion, based on this profile, may represent metastatic esophageal carcinoma. However, synchronous primary tumors cannot be excluded. Clinical correlation required.

Exam: Exams: Thyroid, cardiovascular, lungs, and abdominal exams were normal. Labs: CBC indicated normocytic anemia. Chemistry panel indicated the following abnormalities: Glucose SERUM 127 (H) Urea Nitrogen SERUM 33 (H) Creatinine SERUM 2.2 (H) PT,PTT,INR: Normal Feces Occult blood – Negative on 3 samples Helicobacter Pylori Antibody - Negative

No MeSH data available.


Axial CT image taken from CT Oncology illustrating the esophageal lesion (indicated by straight arrow).
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MPX2499_synpic34892: Axial CT image taken from CT Oncology illustrating the esophageal lesion (indicated by straight arrow).


Squamous Cell Esophageal Cancer

Payne KSP - MedPix (2007)

Axial CT image taken from CT Oncology illustrating the esophageal lesion (indicated by straight arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2499&req=5

MPX2499_synpic34892: Axial CT image taken from CT Oncology illustrating the esophageal lesion (indicated by straight arrow).

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: Squamous Cell Esophageal Cancer

History: 61 y/o male presented with dysphagia x 6 weeks with solid foods. He was able to tolerate some liquid foods. He had modified his diet due to these symptoms. Patient complained of no other symptoms. PMHX: coronary artery disease requiring CABG – 2 vessel, HTN, DM Type I, Hyperlipidemia, chronic esophageal reflux. No history of smoking. +30 year history of alcohol use.

Findings: Barium Esophagram (Not pictured) CONCLUSION: Lower esophageal stricture. This is most concerning for malignancy vs. possible peptic stricture. Recommend GI consult for direct visualization. CT Oncology: IMPRESSION: Findings concerning for distal esophageal carcinoma with regional nodal metastases and possible lung metastases. In particular, the juxtapleural speculated opacity in the left lower lobe may reflect an area of rounded atelectasis, pneumonia, or metastatic focus. Correlate with pending PET scan. PET CT: IMPRESSION: 1. Findings consistent with metabolically active mass in the distal esophagus with a maximum SUV of 13. 2. The left lower lung nodule is metabolically active with a max SUV of 5.1 consistent with metastatic disease. 3. Multiple nodal metastatic disease involving subcarinal lymph node, left infrahilar lymph node and abdominal lymph nodes. 4. Increased metabolic activity present in the left adrenal with a max SUV of 4.6 consistent with metastatic disease.

Ddx: Peptic stricture, achalasia, carcinoma

Dxhow: Pathology – biopsies SPECIMEN: Mass, distal esophagus (Obtained with EGD) CLINICAL DIAGNOSIS AND HISTORY: Dysphagia PRE-OPERATIVE DIAGNOSIS: {None given} POST-OPERATIVE DIAGNOSIS: Operative findings: There was an annular circumferential friable mass present in the esophagus 35.0 to 40.0 cm from the gums. The endoscope could not traverse the lesion and a 6.0 mm pediatric endoscope was then used to complete the exam. The stomach, pylorus, and duodenum appeared normal. GROSS DESCRIPTION: Esophageal mucosal biopsy, submitted are multiple fragments of tan tissue measuring up to 0.2 cm in greatest dimension. FINAL DIAGNOSIS: MASS, DISTAL ESOPHAGUS, MUCOSAL BIOPSY: -- Poorly differentiated carcinoma. (SEE COMMENT) -- Squamous mucosa with acute inflammation, necroinflammatory debris and fungal organisms morphologically consistent with Candida species. -- Actinomyces species identified. Comment: The primary Pathologist favors a squamous cell carcinoma with focal glandular features. SPECIMEN: CORE LUNG BIOPSY CLINICAL DIAGNOSIS AND HISTORY: ESOPHAGEAL CANCER WITH LUNG NODULE, EVAL FOR METS. PRE-OPERATIVE DIAGNOSIS: {None given} GROSS DESCRIPTION: Lung biopsy. Received in formalin are 3 needle biopsies of thin, gray tissue approximately 0.1 cm in diameter and 1.2 cm in length. FINAL DIAGNOSIS: LUNG, NEEDLE BIOPSY: --Poorly differentiated carcinoma. (SEE COMMENT) Comment: The lung tumor and esophageal neoplasm were both stained for cytokeratin 7, cytokeratin 20, and TTF-1. Both lesions have the same profile (cytokeratin 7 positive, cytokeratin 20 positive, TTF-1 negative). The lung lesion, based on this profile, may represent metastatic esophageal carcinoma. However, synchronous primary tumors cannot be excluded. Clinical correlation required.

Exam: Exams: Thyroid, cardiovascular, lungs, and abdominal exams were normal. Labs: CBC indicated normocytic anemia. Chemistry panel indicated the following abnormalities: Glucose SERUM 127 (H) Urea Nitrogen SERUM 33 (H) Creatinine SERUM 2.2 (H) PT,PTT,INR: Normal Feces Occult blood – Negative on 3 samples Helicobacter Pylori Antibody - Negative

No MeSH data available.