Adenocarcinoma of the esophagus.
A 49-year old man with an adenocarcinoma confined to the lower third of
the esophagus. CT imaging studies of the chest and abdomen did not
show any evidence of spread of the disease. The tumor responded well
to neo-adjuvant chemoradiotherapy. He then underwent esophagectomy.
Three months after surgery he presented with a two day history of
dizziness, vomiting and feeeling unwell. A CT scan of his head showed
at least six metastatic deposits.
Comment: Carcinoma of the esophagus may metastasize anywhere, however
the usual sites are local spread, the lungs and the liver. As part of
the initial management of patients with esophageal cancer, imaging
studies include the chest and abdominal cavities - but not the head, as
metastatic disease to the brain is uncommon. Such a case begs the
question of whether the whole body should be scanned in the initial
assessment of this condition.
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