Aziz Rem, Hsu Tina, Toeg Hadi, Sundaresan Sudhir R, Dennis Kristopher
Medicine, University of British Columbia, Vancouver, CAN.
Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, CAN.
Cureus. 2023 Sep 5;15(9):e44717. doi: 10.7759/cureus.44717. eCollection 2023 Sep.
A 76-year-old Caucasian male presented with syncope, intermittent melena, anemia, and unexplained weight loss. Esophagogastroduodenoscopy revealed a friable non-obstructing esophageal tumor that appeared thickened on computed tomography (CT). Biopsies confirmed a poorly differentiated carcinoma. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (F-18 FDG PET/CT) showed intense FDG avidity with a maximum standardized uptake value (SUV) of 23. Although CT did not identify any lymphadenopathy or distant metastases, a mildly enhancing lobulated circumscribed mass with no internal calcification was incidentally identified in the left atrium. Cardiac magnetic resonance imaging (MRI) favored myxoma over thrombus given the signal characteristics and mild enhancement; however, F-18 FDG PET/CT showed an SUV of 18, more consistent with a metastasis. The cardiac mass was resected and shown to be a metastatic focus of poorly differentiated carcinoma, histologically identical to the esophageal mass. He received a single 8 Gray (Gy) fraction of urgent hemostatic radiotherapy for his primary tumor followed by palliative chemotherapy with cisplatin, capecitabine, and pembrolizumab. He was readmitted for transfusion due to recurrent bleeding from his primary tumor and given a second urgent hemostatic fraction of 8 Gy for stabilization. Systemic therapy was eventually discontinued due to declining performance status. He received consolidative palliative radiotherapy (20Gy in five fractions) but continued to deteriorate over the next three months and died in hospice, ten months from the time of his initial presentation.
一名76岁的白种男性出现晕厥、间歇性黑便、贫血和不明原因的体重减轻。食管胃十二指肠镜检查发现一个易碎的非阻塞性食管肿瘤，计算机断层扫描（CT）显示该肿瘤增厚。活检证实为低分化癌。氟-18氟脱氧葡萄糖正电子发射断层扫描/CT（F-18 FDG PET/CT）显示强烈的FDG摄取，最大标准化摄取值（SUV）为23。尽管CT未发现任何淋巴结病或远处转移，但在左心房偶然发现一个轻度强化的分叶状边界清晰的肿块，无内部钙化。鉴于信号特征和轻度强化，心脏磁共振成像（MRI）更倾向于黏液瘤而非血栓；然而，F-18 FDG PET/CT显示SUV为18，更符合转移瘤表现。心脏肿块切除后显示为低分化癌的转移灶，组织学上与食管肿块相同。他接受了单次8格雷（Gy）的原发性肿瘤紧急止血放疗，随后接受顺铂、卡培他滨和派姆单抗的姑息化疗。由于原发性肿瘤反复出血，他再次入院输血，并接受了第二次8 Gy的紧急止血放疗以稳定病情。由于身体状况下降，最终停止了全身治疗。他接受了巩固性姑息放疗（5次分割，共20 Gy），但在接下来的三个月里病情继续恶化，在临终关怀机构去世，距初次就诊时间为10个月。
