Joint Program in Nuclear Medicine

Findings, case of Bright Red Blood per Rectum and Hematemesis

Imaging Findings

EGD/EUS was performed which showed a 1.2 cm circumferential, non-bleeding, friable mass at the gastroesophageal junction which was contained to the muscularis propria. Paraesophageal and gastrohepatic lymph nodes were seen. Esophageal biopsy from this procedure showed moderately to poorly differentiated adenocarcinoma

For staging, the patient had a CT scan followed by a PET scan.

CT showed circumferential thickening at the GE-junction (shown by arrow) consistent with the site of tumor. There were lymph nodes seen at the right hilum (shown by arrow), gastrohepatic ligament (shown by arrow), and celiac axis (shown by arrow).

A PET scan showed high uptake at the GE-junction but did not show high uptake at the sites of lymph nodes seen on CT. The most important lymph node for staging was the celiac axis lymph node. If abnormal high uptake was seen at the celiac axis this would have been considered to be distant metastases and would have staged the patient as stage IV and inoperable.

Follow Up

Patient was staged at T2N1M0 or stage IIB. Patient had neoadjuvant chemotherapy and radiation and surgery 3 months later.

Repeat PET scan after surgery showed no abnormal uptake suspicious for residual or recurrent tumor. Pre- to post-surgical comparison shows marked change in the uptake at the GE-junction (shown by arrow).

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J. Anthony Parker, MD PhD, Tony_Parker@CareGroup.Harvard.edu