Unusual presentation of oesophageal carcinoma with adrenal metastasis
A 55-year-old male was diagnosed to have poorly differentiated squamous cell carcinoma of oesophagus 1 year back. An initial staging computed tomography (CT) scan showed nodal involvement in the celiac, peri-oesophageal and along the gastro-hepatic ligament. A baseline fluorine-18 fluoro-2-deoxyglucose (F-18 FDG) positron emission tomography (PET/CT) scan demonstrated hypermetabolism in the gastro-oesophageal junction growth along with focal areas of hypermetabolism in the liver and lymph nodes. The patient subsequently received six cycles of cisplatin based chemotherapy.\nA repeat endoscopy done after the completion of the chemotherapy showed a small 1.0 × 1.0 cm growth at 30 cm and few small satellite nodules of 0.5 × 0.5 cm size indicating submucosal spread. A repeat PET/CT scan did not show any definite evidence of hypermetabolism in the gastro-oesophageal junction [Figure , ]. However, the left adrenal gland showed a focal area of increased FDG uptake []. The patient was non-compliant to another cycle of chemotherapy. Another PET/CT [] repeated at 3 months showed definite increase in the size of the adrenal lesion [Figure , ]. No FDG avidity was noticed in the image at gastro-oesophageal (GE) junction level [] while the endoscopy revealed subcentimetric nodule in the mucosa. The GE junction growth now showed distinct hypermetabolism []. Multiple liver metastasis [Figure , ] and hypermetabolic foci in the brain were also identified.