Brain Metastasis As The Presentation Of Eesophageal Adenocarcinoma: Should We Image The Brain During The Staging Of Eesophageal Cancer?
P. Creechan1, C. Daniels1, A. Khalid1, M. Hamed1,2
1 St Collumcille’s Hospital, Loughlinstown, Ireland 2 St Vincent’s University Hospital, Dublin, Ireland
We present the case of a patient with brain metastasis as the presentation of oesophageal carcinoma.
Brain metastases from oesophageal cancer has been reported in small case series at a rate of 1.5-3%. With more sensitive imaging modalities and improvements in primary tumour survival the incidence is expected to rise. We aim to precipitate a re-analysis of the use of brain imaging in oesophageal carcinoma.
A 48-year-old male presented with three weeks of episodic headache, dizziness, visual neglect, and unsteadiness. An ex-smoker with a 30 pack-year history, 40 units/week alcohol intake. His history was significant for hypertension. Examination revealed poor balance, co-ordination and rapid alternating movements in the lower limbs bilaterally, but was otherwise normal. Blood tests were normal. CT-brain showed a 2.3cm left parieto-occipital mass with extensive surrounding oedema and 6mm midline shift. MRI-brain appearances suggested likely primary glial tumour. CT-TAP identified a 14mm node at the oesophago-gastric junction and distal oesophagus mildly eccentric circumferential thickening. Urgent craniotomy and resection of the lesion was performed, with histopathology showing metastatic moderately differentiated adenocarcinoma. Oesophago-gastroduodenoscopy revealed a large oesophageal mass extending from the oesophago-gastric junction four centimetres proximally, biopsy revealing invasive moderately differentiated adenocarcinoma.
The patient was referred to St James’s Hospital upper GI multidisciplinary team, he is planned for postoperative stereotactic radiotherapy to the resection cavity.
Our case highlights the necessity for an up-to-date analysis of the incidence of brain metastases in oesophageal cancer and of the efficiency of routine brain imaging in new cases of oesophageal cancer.