대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pleural Metastasis from Esophageal cancer

Radiologic Findings

Chest radiograph shows an about 8 x 7 cm-sized pleural mass in the right lateral costophrenic sulcus. Several surgical clips in right infrahilar area suggest previous operation. Long tubular air-densities overlap with the right side of mediastinal structure. Right pneumothorax is a result of PCNB (percutaneous needle biopsy). CT scans show multiple pleural masses and small amount of pleural effusion. In the posteromedial mediastinum, collapsed stomach is seen. Ivor Lewis operation (lower esophagectomy with esophagogastrostomy) had been perfomed in this patient due to esophageal cancer 6 months before. PCNB was done for pleural mass. Pathological diagnosis was metastatic squamous cell carcinoma histologically identical to esophageal carcinoma.

Brief Review

Carcinomatous metastases to the pleura can originate from almost any organ with the lung as the most frequent primary site, followed by breast, pancreas, stomach, ovary, and etc. Metastasis to the pleura from esophageal cancer is very rare. Distant metastases from esophageal cancer were most commonly diagnosed in abdominal lymph nodes (45%), followed by liver (35%), lung (20%), cervical / supraclavicular lymph nodes (18%), bone (9%), adrenal (5%), peritoneum (2%), brain (2%) and stomach, pancreas, pleura, skin/ body wall, pericardium, and spleen (1% each).
Metastasis, malignant lymphoma or malignant mesothelioma should be considered in the differential diagnosis of multiple pleural masses and effusion. In this case, clue of diagnosis is surgical clips and collapsed stomach in the posterior mediastinum suggesting previous esophageal operation.

References

1. Quint LE, Hepburn LM, et al. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer 1995;76(7):1120-5
2. Bhansali MS, Fujita H, et al. Pattern of recurrence after extended radical esophagectomy with tree-field lymph node dissection for squamous cell carcinoma in the thoracic esophagus. World J Surg 1997;21(3):275-81
3. Armstrong P. Neoplasms of lungs, airways, and pleura. In Armstrong P, Wilson AG, Dee P, Hansell DM. Imaging of diseases of the chest. New York: Mosby, 1995

Keywords

Esophagus, Pleura, Malignant tumor, metastasis,