PMC5045250_01
Upper gastrointestinal endoscopy reveals a smooth stricture with normal overlying mucosa in the lower esophagus starting at 28 cm from central incisor (A). A heterogeneously enhancing soft tissue lesion of size approximately 3.2 cm x 2.5 cm involving the distal thoracic esophagus with near complete lumen occlusion can be seen on the cross-section (white arrow in B) and sagittal section (black arrow in C) contrast-enhanced computed tomography images.
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Upper gastrointestinal endoscopy was suggestive of a smooth stricture with normal overlying mucosa seen in the lower esophagus starting at 28 cm from the central incisor (Fig. 1A). Subsequently, a contrast-enhanced computed tomography (CT) of thorax revealed a heterogeneously enhancing mass lesion at the lower one-third of the esophagus causing near-complete lumen occlusion (Fig. 1B and C).
Endoscopic ultrasound image shows a 3.3 cm x 2.5 cm mixed hypoechoic-isoechoic mass lesion in the submucosal region of distal thoracic esophagus, which was in close proximity to the left atrium (A). Fine needle aspiration of the mass (white arrow) (B). FNA smear showed a cellular smear with clusters of atypical cells with nuclear polymorphism, scant cytoplasm, coarse chromatin, and small nucleoli suggestive of squamous cell carcinoma (C).
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EUS was done revealing a 3.3 cm x 2.5 cm heteroechoic mass lesion in the submucosal region of the distal thoracic esophagus, which was in close proximity to the left atrium (Fig. 2A). EUS-guided FNA of the mass showed a cellular smear with clusters of atypical cells with nuclear polymorphism, scant cytoplasm, coarse chromatin, and small nucleoli suggestive of squamous cell carcinoma (SCC) (Fig. 2B and C).
(A) PET scan images showing FDG avid well-defined soft tissue mass seen in the esophagus extending from the subcarinal region till the lower esophagus with the SUVmax value of 10.69 (white arrow) suggestive of malignant lesion. (B) Hypermetabolic lesion in the right iliac crest with the SUVmax value of 8.66 suggestive of skeletal metastatic involvement (white arrow) is seen.
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To rule out a metastatic disease, a whole body 18-flourodeoxy glucose-positron emission tomography (PET) scan was done, which showed an avid uptake in the esophagus in the region of the mass and in the pelvis, suggestive of bone metastasis (Fig. 3A and B).