Esophageal Metastases and Lymphoma

Michael P. Federle, MD, FACR

R. Brooke Jeffrey, MD

Key Facts

Terminology

Lymphoma: Malignant tumor of lymphocytes

Imaging

Ulcerated/polypoid mass of gastric cardia extending into distal esophagus

Top Differential Diagnoses

Intramural benign esophageal tumor
Esophageal carcinoma
Esophageal varices

Clinical Issues

Most common signs/symptoms
- Dysphagia, weight loss, hematemesis, or asymptomatic
Esophageal metastases
- Direct, lymphatic, or hematogenous spread
- Direct invasion most common: Stomach carcinoma accounts for 50% of cases
Chemotherapy, surgical resection of complicating lesions (obstruction, upper GI bleed)
Complications
- GI bleeding, perforation, obstruction
Prognosis
- Usually poor
Treatment
- Chemotherapy
- Surgical resection of complicating lesions (obstruction, upper GI bleed)

Diagnostic Checklist

Check for history of primary cancer; biopsy required
Overlapping radiographic features of esophageal metastases, lymphoma, and primary carcinoma

(Left) Esophagram in a woman with known lung cancer and dysphagia shows a tight stricture

of the mid-esophagus at the level of the carina. The mucosa is intact, and tapered superior and inferior margins indicate extrinsic or intramural involvement rather than a primary process. (Right) Esophagram in a man with known lung cancer and dysphagia shows a widened mediastinum and a mass in the left hilum. Note the broad shelf-like indentation

along the anterior wall of the mid-esophagus.

(Left) Esophagram in a 70-year-old man with a history of known bladder carcinoma, now presenting with dysphagia, illustrates extrinsic or intramural involvement of the esophagus with eccentric narrowing of the lumen

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