67 year old white male with a history of progressive dysphagia and weight loss. Previous endoscopy showed an esophageal mass with biopsies consistent with adenocarcinoma.
An upper endoscopy and endoscopic ultrasound was performed. From 30 to 42 a long circumferential mass was visualized. As the endoscope was withdrawn proximally a satellite lesion was seen at 22-26 cm from the incisors.
Endoscopic ultrasound with the radial array echoendoscope was used for pre-operative staging. The echoendoscope was pulled within the circumferential distal esophageal tumor. The lesion can be seen as a circumferential hypoechoic mass surrounding the central EUS transducer. The lesion in multiple areas can be seen as irregular outer borders breaking through the muscularis propria into the adventitia. This is consistent with a stage T3 lesion.
Adjacent to the tumor is a round, hypoechoic lymph node with sharp borders. These imaging characteristics are consistent with a malignant lymph node.
The echoendoscope is then pulled into the more proximal esophagus where the satellite lesion is seen at 12 o.clock above the transducer (arrow) and appears to be contained within the esophageal wall and muscularis propria. Another malignant appearing lymph node is below the transducer and adjacent to the aorta.
Overall staging of the esophageal lesion is consistent with a T3N1 esophageal cancer.
Patrick R. Pfau, M.D., University of Wisconsin School of Medicine and Public Health