carcinomal of GEJ case presentation.pptx

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1. Case presentation

2. 24/026 HARGOVIND JOHARI 60/M

3. History: Pt c/o Vomiting and Dysphagia x 1 month, Vomiting, non-bilious, non-projectile 2-3 episodes in a day A/W Dysphagia. Vomiting and Dysphagia got relieved over duration of time with medication. H/o Malena. Ho smoking present. H/o occasional alcohol intake present .

4. Examination: Conscious, Oriented , Pallor + Vitals stable. Abdomen: Soft , non- distended Non tender, B.S+ CVS/RS/CNS-NAD

5. Blood investigations: DATE 25/11/23 HB 8.2 TLC 9000 DLC 57 /32 PLATELETS 1.3L BU/S. CR 28 /1.0 S. ELECTRO. 135/4.9 T. BILIRUBIN .6 SGOT/SGPT 49 /27 ALP 119 T.PROT/S. ALB 6 .8/3.5 PT/INR BG: A POSITIVE CA19.9: 0.6

6. CT SCAN OF ABDOMEN (2/11/23): Liver: lesion of size 4x3.37x3.84cm showing early arterial homogeneous enhancement and isodense to liver on portal venous phase with hypodense surrounding halo is seen involving segment VI of right lobe. Another well-defined hypodense lesion of size 1.38x1.7cm 76cm showing enhancement in arterial and venous phase matching with blood pool insegment VII of right lobe - hemangioma

7. UPPER GI ENDOSCOPY (4/11/23): Oesophagus UES at 15cm, diaphragmatic pinch and SCJ at 40 and 37cm respectively, two nodular lesion of around 1 cm seen at 38cm, Stomach: Fundus: Normal MUCOSA, Duodenum D1/D2- Normal mucosa.

8. BIOPSY (6/11/23): T10525/23: Gastroesophageal junction biopsy Feature are suggestive of moderately differentiated adenocarcinoma, GE junction.

9. CE MRI OF ABDOMEN (13/11/23): A well-defined lesion is seen in segment VI of liver measuring 4x4x4cm (APXTRXCC), It appears hyperintense on TIWI and iso to mildly hyper on T2WI ? hepatic adenoma. Few areas of mild diffusion restriction is seen within. lesion is seen in segment VII of liver following blood pool in all phases measuring-14x12mm s/o flash filling hemangioma. .

10. PET CT (21/11/23): supraclavicular lymph node is noted, measuring 11 x 7 mm. SUVmax-4.7. subpleural nodular lesion with focal cavitation, measuring-22 x 14 mm is noted in the anterior segment of right lung upper lobe SUV max-2.6. irregular intramural thickening is noted of the gastro- oesophageal junction and cardia of stomach, maximum thickness measuring - 14 mm. SUV max-10.7, for a length of 20 mm.

11. DIAGNOSIS : Ca GEJ with liver SOL (benign) with right subpleural nodule (? mets ) MANAGEMENT: