Compiled by: Margaret D. Phillips, M.D.
History: Esophageal carcinoma. Evaluate for metastatic disease.
Examination: MRI of the brain. Figure 1 - T1 weighted axial, post contrast. Figure 2 proton density weighted coronal, post contrast. Figure 3 - T2 weighted, axial. Figure 4 - T2 weighted, axial. Figure 5 - T1 weighted, axial. Figure 6 - T2 weighted axial.
Findings: The axial and the coronal images demonstrate a heterogeneous, lobular, dural-based mass in the right inferofrontal region, extending into the middle cranial fossa, encroaching on the carotid artery and compressing the 3rd ventricle. It results in obstructive hydrocephalus. Additional dural-based masses are present, and there are intraaxial enhancing parenchymal nodules in the supra- and infratentorial regions. No calvarial destruction.
Diagnosis: Dural-based and parenchymal metastatic foci from esophageal carcinoma primary.
Discussion: Esophageal carcinoma has an extremely rare propensity to cause brain metastases, reported in one study at 3.6%.1
Histology, and therefore radiographic appearance, of esophageal CNS metastases varies with the patient’s country of origin. In the United States, the most common histology is adenocarcinoma, while in Japan and India it is squamous cell carcinoma.2 The squamous cell and small-cell carcinoma (a rare variant form) may exhibit cystic lesions with thin enhanced rims on MRI.3
The presence of brain metastases is frequently associated with an absence of lung metastases and correlates with a generally poor prognosis.4
Esophageal brain metastases can be dural-based lesions.5
Dural metastases typically are hematogenously spread lesions from an extracranial primary. With purely dural metastases, breast cancer is the most common etiology. Lymphoma is the second most common. Other primary sites include lung, prostate, and melanoma in adults, and adrenal neuroblastoma and leukemia in children. Classic MR findings of dural metastases are biconvex masses displacing brainwith T1 hypointensity to gray matter, T2 predominant hyperintensity relative to gray matter, and T1 postcontrast enhancement. 6
The differential diagnosis includes inflammatory lesions such as granulomatous infections (mycobacterial, encephalitic, and fungal), sarcoidosis, Langerhans cell histiocytosis, and Erdheim Chester.7
