Metastatic lymph node and osteolytic skeletal metastasis detected by FDG-PET in an endoscopy-diagnosed early-stage esophageal cancer

A 50-year-old man who had chronic peptic ulcer disease with an early-stage squamous cell carcinoma in the lower third of the esophagus. The primary tumor was not visualized on an FDG-PET study. However, a paraaortic lymph node metastasis in the upper abdomen was demonstrated in this initial staging. The patient underwent an operation at another hospital. The postoperative staging was classified as stage I (TINOMO: tumor invasion limited to submucosa, no regional lymph node metastasis 0/47, no distant metastasis). One year later, a protruding firm mass developed over the sternum. Follow-up FDG-PET showed foci with intense activity in the sternal and epigastric regions. Although conventional MDP bone scan did not clearly show the lesion, an osteolytic skeletal metastasis to the sternum and progressive enlargement of the metastatic paraaortic lymph node were identified by PET. opyright