Calcified gastric carcinoma: CT findings

The computed tomographic (CT) findings of 13 cases of calcified gastric carcinoma were analyzed retrospectively. Eleven cases were confirmed as a mucinous adenocarcinoma by surgery (three cases), or endoscopic biopsy (eight cases). Two cases were diagnosed as adenocarcinoma by endoscopic biopsy. In all cases the calcifications were of the punctate or miliary shape and the size varied from 1–3 mm in diameter. The calcifications were located in the thickened gastric wall in all cases, and were seen in metastatic lesions such as lymph nodes and the liver in two cases. In 10 cases, some tumor portions showed lower attenuation number than that of the muscle on CT scans, and corresponded to mucin pool in tumor portions histologically. Twelve cases were in inoperable advanced stage.     

CT findings in metastatic ovarian tumors from gastrointestinal tract neoplasms (Krukenberg tumors)

The computed tomographic (CT) findings are reviewed in 7 patients with metastatic ovarian tumors from gastrointestinal tract neoplasms (Krukenberg tumors). All patients presented mixed ovarian masses. In 6 cases the masses were mainly cystic, with internal septa and focal or uniform enlargement of the cyst wall. In the seventh patient the ovarian mass appeared on the CT as mainly solid. The size of the neoplasm varied between 5 and 46 cm. Ascites was only seen in 1 case and in another the existence of a primary tumor in the sigmoid colon was demonstrated. In our cases the CT signs of ovarian metastasis were indistinguishable from primary tumors of the ovary.     

Carcinoid tumors of the abdomen: CT features

Carcinoid tumors are rare neuroendocrine neoplasms that belong to a more general category of tumor called the APUDomas. Ninety percent of carcinoid tumors are located in the gastrointestinal tract. Abdominal carcinoid tumors are categorized according to the division of the primitive gut from which they arise. Carcinoid tumors originating from the foregut develop in the gastric wall, duodenum, and pancreas; those originating from the midgut develop from the small bowel, appendix, and right colon; and those originating from the hindgut develop from the transverse or left colon or from the rectum. This report illustrates the computed tomographic appearance of primary and metastatic carcinoid tumors of the abdomen. Among the different organs that may be involved by metastases from carcinoid tumor, special emphasis is placed on the liver.     

Gastrointestinal leiomyosarcoma — Unusual sites: Esophagus,colon and porta hepatis

This paper is based on a retrospective analysis of the radiologic findings of 6 newly proven cases of primary gastrointestinal leiomyosarcomas located in unusual sites. The radiographic and angiographic features of esophageal, colonic, and porta hepatis leiomyosarcomas are described and illustrated. General background information together with a brief review of the literature regarding these lesions are provided. The difficulties encountered in the preoperative diagnosis are explained by the protean and nonspecific clinical and radiographic features of many of these tumors. In addition, although myomatous tumors of the liver and porta hepatis are angiographically hypervascular, similar tumors of the colon are slight to moderately vascular, and tumors of the esophagus are avascular.     

Carcinoid tumors of the alimentary tract

The angiographic findings of five small intestinal and two colonie carcinoids are described and illustrated, together with a review of the pertinent literature. It is pointed out that the demonstration of a complex of angiographic findings related to the primary site, mesentery, and liver is highly specific. It helps in the preoperative diagnosis as well as in the localization and stage of development of the gastrointestinal carcinoid. The triad of findings is composed of: (a) faint to moderate staining at the primary site; (b) narrowing, obstruction of the distal mesenteric arcade, cluster of irregular kinked vessels, and encasement in the more central areas of mesentery; and (c) hypervascular liver metastasis. The colonic lesions examined are unique in the literature, and exhibited angiographic findings similar to the small bowel carcinoids.     

原发性小肠肿瘤X线及CT表现

目的分析原发性小肠肿瘤的X线及CT表现,探讨其诊断价值.方法回顾分析经手术病理证实的原发性小肠肿瘤28例的临床资料和小肠钡剂造影及CT表现.28例均行数字化小肠气钡追踪造影,2例行小肠灌肠造影,7例行多层螺旋CT扫描.结果原发性小肠肿瘤小肠气钡造影表现包括充盈缺损、管腔狭窄、黏膜破坏或受压、管壁僵硬、龛影、肠梗阻或肠套叠.CT扫描表现为软组织块影、管壁增厚及肠管受压或狭窄.结论原发性小肠肿瘤X线表现具有一定特征,结合临床表现可明确诊断,与CT检查相结合可提高诊断率.     

超声内镜对结直肠黏膜下病变的诊断价值

目的探讨超声内镜(EUS)在结直肠黏膜下病变诊断和治疗中的作用。方法对结直肠黏膜下病变进行EUS检查。根据黏膜下病灶的起源层次,部分患者接受深挖活检、超声内镜引导下细针穿刺吸取活检术(EUS-FNA)、内镜下治疗或外科手术。回顾性分析EUS诊断结果与临床病理的相关性。结果 EUS检查的74例患者中,诊断神经内分泌肿瘤28例(均位于直肠);脂肪瘤15例(其中位于回盲部4例、横结肠1例、升结肠8例、乙状结肠2例);直肠间质瘤2例(固有肌层和黏膜肌层各1例);外压性改变14例(卵巢肿瘤9例,淋巴结2例,盆腔肿瘤3例);囊肿5例(横结肠4例、升结肠1例);气囊肿1例;乙状结肠子宫内膜异位3例;直肠周边恶性肿瘤侵犯4例;肠道淋巴瘤2例。所有病灶均接受深挖活检、EUS-FNA、内镜下治疗或外科手术。最终病理和EUS诊断符合率为68/74(91.9%),其中2例EUS考虑直肠类癌最后病理确诊为黏膜肌层来源的平滑肌瘤。1例考虑脂肪瘤最终确诊为肠道淋巴瘤。2例考虑直肠周边恶性肿瘤最终为炎性包块,1例考虑子宫内膜异位症最终诊断为直肠癌。结论 EUS能清晰地显示消化道各层结构,能清楚显示结直肠黏膜下病变的大小、起源及其与相邻结构的关系,并且能较精确地判断各种病变的性质,进而指导结直肠黏膜下病变的治疗。     

Intraductal papillary carcinoma of the pancreas

We report a case of intraductal papillary adenocarcinoma of the distal pancreatic duct. Although a rare subgroup of exocrine pancreatic tumors, their diagnosis is an important one in view of their favorable prognosis with pancreatectomy. Because of the established behavior of villous tumors of the colon, to which they are similar histologically, these tumors should be resected, even if biopsy shows benign disease. Patients should be followed radiologically for recurrence or the development of new adenoma following resection.     

Primary lymphoma of the colon and rectum: CT and barium enema correlation

This paper presents the computed tomographic (CT) and barium enema (BE) findings in seven patients with proven primary lymphoma of the colon and rectum. CT and BE examination are complimentary studies in the evaluation of primary lymphoma of the colorectum, and certain relevant findings may be missed when radiographic evaluation does not include both modalities. Both CT and barium studies are very accurate in detecting bulky endoexoenteric tumor masses, although CT may suggest features which can differentiate primary lymphoma from adenocarcinoma. The real utility of obtaining both a CT and BE examination may lie more in diagnosing complications, such as fistula formation and in the evaluation of subtle infiltrative lesions. While CT is necessary for staging purposes, BE examination may be invaluable for detecting subtle mucosal filling defects which could be missed on CT.     

Annular malignancies of the small bowel

True annular malignancies of the small bowel with mucosal destruction and shelflike margins are generally thought to be caused by primary adenocarcinoma. At our institution, 18 annular malignancies were diagnosed radiographically in the small bowel by enteroclysis (16 cases) and conventional small bowel follow-through studies (2 cases) between 1977 and 1984. However, pathologic data revealed only 4 primary adenocarcinomas with 10 metastatic lesions (6 colon cancers, 2 malignant melanomas, 1 lung cancer, and 1 cervical cancer), 2 leiomyosarcomas, 1 non-Hodgkin's lymphoma, and 1 malignant carcinoid tumor. While these lesions may be indistinguishable radiographically, annular carcinomas tended to be short, relatively nonobstructing lesions; annular metastases (except those from malignant melanoma) tended to be highly obstructing lesions with significant narrowing and/or angulation of the bowel. Leiomyosarcomas, lymphoma, and metastases from malignant melanoma tended to be longer lesions with extensive ulceration, wider channels, and little or no evidence of obstruction. Nevertheless, surgical resection or biopsy of the lesion is ultimately required for a definitive diagnosis.     

Gastrointestinal carcinomas in renal transplant recipients

The development of malignancies in renal transplant recipients is well documented. Typically, these are cutaneous tumors or lymphomas. During the past 5 years, we have encountered six patients with documented carcinomas of the gastrointestinal tract, which developed after these patients received renal transplants. These carcinomas developed at an average of 10 years (range 2–16 years) after renal transplantation. There were three carcinomas of the colon, and one each of the esophagus, stomach, and anal canal. In many instances, the patients had examinations prior to transplantation which were normal. Several surveys of transplant recipients indicate there is an increased incidence of gastrointestinal tract malignancies after transplantation. These studies also recommend that screening of the gastrointestinal tract in long-term transplant recipients be performed. Since these patients are often imaged in the radiology department, radiologists must be aware of this possible complication.     

Delayed diagnosis of ascending colon mucinous adenocarcinoma with local abscess as primary manifestation: Report of three cases

BACKGROUNDColorectal mucinous adenocarcinoma is a distinct subtype of colorectal adenocarcinoma that is not sensitive to chemotherapy and radiotherapy, and its prognosis is worse than that of nonmucinous adenocarcinoma. Early diagnosis and aggressive surgical treatment may be the key to improving the prognosis of patients. Ascending colon mucinous adenocarcinoma with the primary manifestation of a local abscess caused by non-intestinal perforation has never been reported. Moreover, since the lumen of the ascending colon is large, and early stage ascending colon cancer lacks typical clinical manifestations, the diagnosis may be delayed easily. We herein report three cases of delayed diagnosis of colorectal mucinous adenocarcinoma.CASE SUMMARYWe present three patients (two females and one male) with mucinous ascending colon mucinous adenocarcinoma with the primary manifestation of a local abscess (the right area of the lumbar spine, right groin, and lower right abdomen) caused by non-intestinal perforation. At the initial clinical visit, the common causes of those abscesses, including spinal tuberculosis and urinary tract infection, were excluded. The treatment of the abscess was through an incision and drainage. However, the source of the abscess was not made clear, which led to an abscess recurrence and a delayed diagnosis of colorectal mucinous adenocarcinoma. After the patients were referred to our hospital, a definitive diagnosis of ascending colon mucinous adenocarcinoma was made with the help of tumor markers and colonoscopic findings. Because of the delayed diagnosis of the disease, two patients (case 1 and case 2) missed the chance of surgery due to disease progression and died in a short follow-up period. Only case 3 underwent radical surgery for the tumor in the right colon and partial abdominal wall resection and achieved a better prognosis.CONCLUSIONAbscesses in the right area of the lumbar spine, right groin, or right lower quadrant caused by non-intestinal perforation as the primary clinical manifestation of ascending colon mucinous adenocarcinoma are extremely rare. Mucinous adenocarcinoma of the ascending colon may be one of the causes of such abscesses. Performing colonoscopy as soon as possible is of great significance in the diagnosis and treatment of the disease.     

女性非妇科盆腔肿物12例超声特征及误诊探析

目的探讨超声检查对女性非妇科盆腔肿物的诊断价值。方法回顾性分析2008年7月—2013年7月收入我院妇科手术的12例非妇科盆腔肿物的超声声像图特点及其他临床资料。结果术前超声检查12例共13个肿物,呈囊实性7例,实性5例,囊性1例;诊断卵巢肿瘤6例,子宫浆膜下肌瘤4例,盆腔肿物(性质待定)2例。12例均行手术探查,并经术后病理检查确诊。术后病理检查示12例中肿物来源于胃肠道6例(50.0%),腹膜后肿瘤4例(33.3%),其他部位肿瘤2例(16.7%);小肠间质瘤3例,腹膜后平滑肌瘤、腹膜后神经鞘瘤各2例,阑尾黏液腺癌、盆壁侵袭性血管黏液瘤、乙状结肠系膜畸胎瘤、非霍奇金B细胞淋巴瘤及肠系膜巨大囊肿各1例。结论女性非妇科盆腔肿物术前超声检查易误诊为卵巢肿瘤和子宫浆膜下肌瘤,超声科医师结合临床特征进行诊断及避免思维定式可减少误诊。     

胃肠梭形细胞肿瘤49例临床病理分析

目的 探讨3种胃肠梭形细胞肿瘤的临床病理特点及诊断与鉴别诊断。方法 复习49例胃肠梭形细胞肿瘤的HE切片并行免疫组化染色，重新明确诊断，对每类肿瘤的临床病理资料和组织形态进行分析。结果 根据免疫组化结果分类：①胃肠道间质瘤39例（39／49），中位年龄56岁；其中胃23例，19例发生于胃底、体部；小肠7例，结直肠3例，食管2例，肠系膜及网膜4例。光镜见瘤细胞梭形和／或上皮样，排列成交叉束状、栅栏状、假菊形团样、弥漫状等，其中24例可见间质灶状水肿区，14例伴有不同程度的炎细胞浸润。②胃肠平滑肌瘤6例（6／49），中位年龄37．5岁；2例位于食管，4例发生于胃，其中3例位于胃贲门。肿瘤细胞呈梭形、温和，2例伴有灶性钙化。③施万瘤4例（4，49），中位年龄48岁；均位于胃，其中3例位于胃体，1例胃窦。光镜下4例均见淋巴细胞套，3例见细胞密集与稀疏交替区，3例见局灶异型细胞，核分裂罕见。结论 胃肠梭形细胞肿瘤几乎均为间叶起源，其中胃肠间质瘤最常见，但平滑肌瘤与施万瘤仍然存在。与间质瘤和施万瘤相比，平滑肌瘤发病年龄较低。前两者好发于胃底、体部，平滑肌瘤好发于消化道上段。各类肿瘤形态学具有部分可识别的特征，但明确诊断有赖于免疫组化。     

Sonographic findings in intussusception caused by a lipoma in the muscular layer of the colon

Lipomas of the gastrointestinal tract are uncommon tumors. Almost all gastrointestinal lipomas are submucosal or subserosal, and most are asymptomatic, although they may cause abdominal pain, bowel obstruction, and gastrointestinal bleeding. The diagnosis of gastrointestinal lipoma is usually not made before surgery. We present a case of colonic intussusception caused by a lipoma that was located in the muscular layer of the colon and was diagnosed preoperatively by sonography. The descending colon appeared edematous and thick. There was layering within the lumen of the descending colon, mimicking the target sign. At the distal end of the intussusception, there was a 4.7-cm, hyperechoic, rounded lesion with a smooth margin. Surgery revealed a polypoid mass originating from the splenic flexure and causing intussusception of the colon, and pathologic analysis confirmed the diagnosis of lipoma of the muscular layer of the colon.     

27例胃肠道间质瘤的影像学分析

目的:探讨胃肠道间质瘤的影像学表现。材料与方法:27例胃肠道间质瘤,其中17例行超声检查,7例行MSCT检查,包括常规检查及增强检查,5例行X线数字胃肠,1例行MRI检查。27例同时进行手术切除和病理检查。结果:本组27例胃肠道间质瘤,发生在食道1例(3.7%),胃8例(29.6%),其中1例合并食道小平滑肌瘤,1例合并肝脏转移瘤;小肠16例(59.2%),其中1例合并肝转移瘤,1例合并腹壁转移;直肠2例(7.4%)。发生在胃和小肠共24例(88.9%)。所有的病例都进行免疫组化CD117和CD34检查。并对胃肠道间质瘤的影像学特征进行讨论。结论:通过对胃肠道间质瘤的影像学和免疫组化特征的讨论,提高对其的认识和诊断水平。     

原发性小肠恶性肿瘤消化道钡餐与CT对照分析

目的：评价各种成像技术（传统消化道钡餐、CT、血管造影）诊断原发性小肠恶性肿瘤的价值，提高对小肠恶性肿瘤的认识。材料与方法：回顾性分析了43例经手术证实的原发性小肠恶性肿瘤影像资料。结果：病变包括腺癌17例，平滑肌肉瘤6例，淋巴瘤20例。消化道钡餐主要X线表现为胸腔狭窄，肠腔内充盈缺损，管壁僵硬，粘膜破坏，环状皱壁消失，肠梗阻或肠套叠，肠管扩张及溃疡形成。CT检查11例，均确诊为小肠恶性肿瘤。血管造影2例，均拟诊为小肠血管畸形。结论：凡临床疑有小肠恶性肿瘤通常首选胃肠造影法，若诊断不明或为手术前进一步明确病变的范围宜用CT检查，对不明原因反复发生的上消化道出血血管造影具有重要价值。     

小肠肿瘤21例临床分析

目的 总结原发性小肠肿瘤的诊断及治疗方法.方法 回顾性分析21例小肠肿瘤的临床资料.结果 21例均经手术和(或)病理检查证实诊断,其中良性肿瘤8例,恶性肿瘤13例.术前诊断符合率52.9%.主要表现为腹痛、腹部包块、肠梗阻及消化道出血等.本组均行手术治疗,无手术死亡.结论 小肠肿瘤缺乏特异性体征,术前误诊率高.对有出血、腹痛、梗阻、包块等临床表现者应怀疑本病可能;对诊断不明者应综合采用各种检查,必要时剖腹探查,一经诊断,应及时手术治疗.     

Complete healing of ulceration within a gastric leiomyoma

A case of an ulcerated, bleeding gastric leiomyoma is presented in which a follow-up UGI examination showed no evidence of residual ulceration within the tumor. Radiologists should be aware that it is occasionally possible to document complete healing of ulceration within a gastric leiomyoma and that conservative medical management may be an alternative when surgical resection cannot be performed.     

MRI Manifestations of gastrointestinal wall thickening

The appearance of gastrointestinal wall thickening of various entities is demonstrated on magnetic resonance imaging (MRI). The entities include benign gastric ulcer, gastric carcinoma, pancreatic carcinoma with direct invasion of stomach, duodenal leiomyoma, radiation enteritis, peritonitis, colonic carcinoma, recurrent carcinoma at the gastrojejunal anastomosis with direct extension to the transverse colon, colocolic intussusception, sigmoid diverticulitis with pericolonic abscess and fistula into the urinary bladder, and lymphoma of the stomach, duodenum, small bowel, and colon. Air was introduced antegradedly or retrogradedly into the alimentary tract to act as a contrast agent. When the bowel was distended by air, the normal bowel wall was barely visible or even invisible. Abnormal focal or segmental wall thickening was outlined between the intraluminal air and extraluminal fat. In some instances, the thickenings were better demonstrated on coronal or sagittal sections. The proper muscular layer of the bowel has a low-signal intensity and was delineated between the thickened mucosa—submucosa and extramural fat. Interruption of this low-intensity zone might represent tumor invasion through the muscular layer.An invited commentary on this article follows on pp. 403–404.