Remote metastasis to the gastric cardia in esophageal carcinoma: CT findings

To assess the CT findings of remote metastasis to the gastric cardia in patients with esophageal carcinoma. Among patients with esophageal carcinomas treated between Jane 1994 and May 1999, five males aged 65-75 (mean, 67.4) years with histologically proven remote metastasis to the gastric cardia from esophageal squamous cell carcinoma, detected at surgery (n=2) or endoscopic biopsy (n=3), underwent CT scanning. We retrospectively evaluated the findings in terms of the location, size appearance of each lesion and the presence or absence of associated lymphadenopathy. The primary esophageal carcinomas were located in the middle third (n=4) and lower third (n=1) of the esophagus. All five gastric metastases were solitary and occurred in the gastric cardia, and were separated from the primary tumors. CT showed that the metastases ranged in size from 4.2 to 8.0 (mean, 6.7) cm, and all were large than the primary tumors. All were ulcerated, and in four cases there was associated abdominal lymphadenopathy. They were all well defined, poorly enhanced, submucosal masses that were endogastric in three cases and exogastric in two. The latter were difficult to differentiate from extrinsic masses compressing the gastric cardia. Our results suggest that when a submucosal gastric cardia mass with associated lymphadenopathy is detected by CT during the initial staging or follow-up evaluation of esophageal carcinoma, remote gastric metastasis should be considered