Endoscopic ultrasonography in the diagnosis and staging of neoplasms of the head and neck

BACKGROUND AND STUDY AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a minimally invasive and highly accurate method of detecting mediastinal lymph-node metastases in gastrointestinal and lung cancer. Little information is available regarding the use of EUS-FNA to stage tumors in the head and neck region. This study reports experience with EUS in the diagnosis and staging of these tumors and their mediastinal spread. PATIENTS AND METHODS: The records of patients who underwent EUS for diagnosis and/or staging of head and neck tumors were reviewed. Referral criteria were suspected invasion of the esophagus by a lower-neck mass on cervical computed tomography (CT) or magnetic resonance imaging (MRI), or mediastinal lymphadenopathy > 10 mm on a chest CT. RESULTS: Thirty-two patients (23 men, nine women; mean age 65 years, range 44 - 80) were referred and underwent 35 EUS examinations. In one patient, EUS was not possible due to a benign esophageal stricture. In 17 patients with suspected esophageal invasion on CT scans, EUS demonstrated invasion of the esophagus in four cases and of the pleura in one; 12 tumors showed no visible invasion of adjacent structures. The other 17 examinations were carried out for suspected mediastinal metastatic disease. In eight cases, EUS-FNA confirmed metastatic disease, whereas only benign changes were shown in the other nine cases. EUS-FNA also provided the first tissue diagnosis in two primary tumors and identified malignancy in one patient with no CT suspicion of positive mediastinal lymph nodes. EUS avoided the need for more invasive investigations in all patients with mediastinal lymphadenopathy, and it changed the management in 12 of the 17 patients (71 %) with suspected esophageal invasion and in eight of the 17 patients (47 %) with suspected mediastinal disease. CONCLUSIONS: EUS with FNA provides a viable approach to the diagnosis and staging of tumors in the head and neck region when there is a suggestion of esophageal invasion on CT or MRI, or enlarged mediastinal lymph nodes. EUS with FNA may avoid the need for mediastinoscopy or other more invasive techniques for staging of these neoplasms.     

CT扫描及微探头超声内镜术前评价进展期食管癌

目的　比较胸部螺旋CT增强扫描及微探头超声内镜 (MPS)检查在评价进展期食管癌的价值。方法　 3 2例进展期食管癌术前行CT扫描和MPS检查并与术后病理学比较。结果　CT扫描能发现 82 .9%的食管癌病灶 ,但不能准确诊断癌肿浸润深度。诊断纵隔结构受侵准确率 75 % ,发现区域淋巴结转移敏感性 91.7% ,特异性 80 .5 % ,对纵隔内远处淋巴结转移诊断准确率 80 %。MPS检查能检出所有病例的进展期食管癌病灶 ,癌肿浸润深度诊断准确率 81.5 % ,诊断纵隔结构受侵准确率 5 0 % ,诊断区域淋巴结转移敏感性 88.9% ,特异性 77.8% ,而对纵隔内远处转移的淋巴结均未能探及。结论　CT扫描在评价纵隔内结构受侵及远处淋巴结转移的意义较大 ,而MPS检查在判断癌肿管腔浸润深度的准确率较高。     

Primary and secondary malignancies of the penis: ultrasound features

Cancer of the penis is a rare neoplasm in developed countries but worldwide represents a significant health problem. In this study, the ultrasonographic features of primary and secondary malignant lesions of the penis are described. Squamous cell carcinoma usually presents as a hypoechoic lesion with heterogeneous appearance. Invasions of the corpora cavernosa and the corpus spongiosum are appreciable. B-cell lymphoma presents as a well-vascularized mass, a plaque, or ulcers in the penile skin. Penile metastases result from hematogenous or lymphatic spreading of distant tumors or, more frequently, as penile infiltration by tumors from adjacent organs. Diffuse corporeal or nodular involvement can result. 1Award-winning poster at the 10th European Symposium on Urogenital Radiology; Uppsala, Sweden, September 4•7, 2003.     

超声内镜在食管结核诊断中的9例应用并文献复习

目的总结食管结核超声内镜(EUS)声像图特征及其他临床资料结果,提高该病的诊断率。方法回顾性分析该院2011年6月-2016年5月经EUS检查或内镜超声引导下细针穿刺活检(EUS-FNA)而确诊为食管结核的9例患者的临床资料,并复习国内外文献。结果 9例患者中,表现为吞咽梗阻6例,胸骨后疼痛3例,伴有盗汗、低热症状2例,伴咳嗽、咯血1例,伴咽痛1例;病变位于食管中段7例(77.78%),上段1例,食管下段合并咽部病变1例;8例为隆起型病变,其中4例表面破溃,1例呈息肉样隆起,另1例为溃疡并憩室型病变;内镜下活检6例中5例确诊,其中3例活检2次;EUS表现为食管壁内不均质低回声占位,边界模糊,内见高回声光斑,侵及黏膜下层或全层,部分病灶突破外膜层与壁外肿大淋巴结融合贯通;2例行EUS-FNA穿刺,病理发现炎性肉芽肿,考虑结核;均予以抗结核治疗后症状缓解。结论食管结核临床表现主要为吞咽困难,好发于食管中段,内镜下表现主要为隆起型和溃疡型病变,通过多次内镜下活检,结合EUS特征或EUS-FNA穿刺病理学检查能明显提高该病的诊断率,减少误诊率。     

海绵窦肿瘤的CT和MRI表现

[目的]探讨海绵窦肿瘤的CT和MRI特征.[方法]回顾分析89例经病理证实的海绵窦肿瘤的CT和MRI资料,包括垂体瘤25例、鼻咽鼻窦肿瘤29例、鞍旁脑膜瘤14例、鞍旁胆脂瘤3例、三叉神经鞘瘤6例、海绵窦转移瘤4例、鞍区脊索瘤5例、鞍旁软骨肉瘤2例和鞍旁骨软骨瘤1例.[结果]双侧海绵窦受累26例,单侧受累63例.肿瘤表现为病变侧海绵窦扩大和外缘膨隆(89例)、海绵窦CT密度异常并不同程度强化(62例)、海绵窦MR信号异常并不同程度强化(68例)、颈内动脉受累(76例)和颅底骨质破坏(47例).[结论]海绵窦肿瘤主要表现为海绵窦形态、密度或信号异常、颈内动脉及邻近结构受侵.     

Biopsy methods and pathology of Barrett's esophagus

We reviewed the definition of the esophagogastric junction and the biopsy sites and histologic findings of biopsy specimens from Barrett's esophagus. The borderline between the esophagus and stomach has been defined as the distal limit of the longitudinal vessels by the Japan Esophageal Society, because the longitudinal vessels are always located within the esophagus. As squamous islands in Barrett's mucosa are usually the orifices of esophageal glands proper, biopsy specimens from the squamous islands show esophageal glands proper or their ducts. The identification of esophageal glands proper is a definite histological indicator that a piece of biopsy tissue is of esophageal origin. Therefore, a diagnosis of Barrett's esophagus can be made purely on the basis of the histologic findings in these biopsy specimens of squamous islands. Since columnar mucosa is usually recognizable at endoscopy, a diagnosis of Barrett's esophagus can be made solely on the basis of endoscopic examination, without any need for histologic confirmation, if squamous islands are recognized in columnar-lined mucosa.     

重度反流性食管炎的X线造影表现特点

目的探讨重度反流性食管炎的X线造影表现特点,以提高对该病的影像诊断水平。方法回顾性分析伴有溃疡或狭窄的重度反流性食管炎32例,所有病例均经内镜活检或细胞学证实,其中11例经手术及病理证实。结果32例中发生于食管下段27例(84.4%),中下段4例(12.5%),上段1例(3.1%);病变长度1~4cm,平均3.7cm。黏膜不规则28例(87.5%);黏膜呈小结节状或息肉状改变14例(43.8%);合并食管溃疡16例(50%)。锥形狭窄13例(40.7%),弧形狭窄12例(37.5%),不规则结节状狭窄7例(21.9%)。病变与正常食管壁分界清楚及不清楚者各16例(50%)。假性憩室者8例(25%),固定的横行黏膜纹4例(11.8%),病变上端食管局限性囊袋样膨出9例(28.1%)。局部管壁柔软19例(59.4%),僵硬13例(40.6%)。病变下缘累及贲门者5例,合并食管裂孔疝22例(71.9%)病例中病变下缘均累及膈上疝囊。结论重度反流性食管炎的X线造影多表现为食管下段狭窄、溃疡,合并食管裂孔疝,如发现假性憩室、固定的横行黏膜纹及病变上端食管局限性囊袋样膨出等征象则有助于诊断。     

Metastatic disease of the ureter: Patterns of tumoral spread and radiologic findings

The radiographic and sectional imaging features (ultrasound [US], computed tomography [CT], and magnetic resonance imaging [MRI]) of ureteral obstruction due to metastatic disease are reviewed. The radiologic findings depend on the pattern of the tumoral spread: hematogenous submucosal/mucosal metastasis, hematogenous adventitia metastases spreading along periureteral vessels, scirrhous metastatic spread along periureteral vessels, or metastatic spread into lymph nodes with perinodal desmoplastic reaction. Solitary or multiple extraluminal obstructions without substantial displacement of the ureter are characteristic. CT is the examination of choice for morphological analysis. Together with the patient's history and clinical data, a presumptive diagnosis of ureteral obstruction caused by metastatic disease can be made.     

115例眶内肿瘤CT分析

目的:回顾性探讨115例眶内肿瘤CT影像学特点,为临床诊断和治疗提供影像学依据。方法:搜集115例眶内肿瘤患者的临床资料和CT影像学资料进行回顾性分析。115例中经手术及穿刺活检病理证实为眶内海绵状血管瘤者33例、炎性假瘤30例、皮样囊肿12例、多形性腺瘤11例、腺样囊性癌6例、脑膜瘤6例、神经鞘瘤6例、神经纤维瘤2例、眶内转移瘤3例(包括肺癌2例、结肠癌1例)、继发性肿瘤1例(视神经母细胞瘤眶内浸润)、横纹肌肉瘤、脂肪瘤、淋巴瘤、原发性眶内黑色素瘤及恶性血管内皮细胞瘤各1例。结果:良性肿瘤CT表现为大多数呈边缘清楚圆形、椭圆形肿块,与周围组织分界清楚,压迫周围组织造成移位,眶壁骨质无破坏。恶性肿瘤大多数呈边界不清,形态不规则肿块,与周围组织分界不清,可压迫或包绕周围组织,眶壁骨质破坏。CT定位诊断率100%,定性诊断率76.8%(88/115),良性肿瘤定性诊断率达80.1%(81/101),恶性肿瘤定性诊断率50%(7/14)。结论:眶内肿瘤具有一定的CT影像学特征,根据CT影像学特点及临床表现可对大多数眶内肿瘤作出定性诊断。     

Patterns of lymphatic drainage and lymph node involvement in esophageal cancer

The esophagus has a complex pattern of lymphatic drainage. Lymph node involvement and number of lymph node metastases are very important prognostic factors, and the newly revised TNM staging system for esophageal cancer reflects this. Knowledge of the location and nomenclature of the common nodal stations in the thorax and upper abdomen is essential for the accurate staging of these patients. PET–CT and EUS are essential in the routine staging of esophageal cancer patients. The aim of this pictorial review is to present the nodal stations, nomenclature and location of regional lymph nodes in esophageal cancer using PET–CT and EUS images from selected patient cases. We will review the EUS and PET–CT imaging for a number of patients with esophageal cancer, using cases which highlight the advantages and diagnostic pitfalls for these imaging modalities.     

内镜超声检查对食管隆起性病变的诊断价值

目的 探讨超声内镜对食管隆起性病变的诊断价值。方法 对161例食管隆起性病变患者行内镜超声检查。结果 发现黏膜下肿瘤92例，其中肌原性肿瘤86例，脂肪瘤4例，囊肿2例，息肉14例，静脉瘤（静脉曲张）34例；外压性改变21例，其中胸主动脉外压18例，纵隔肿瘤3例。结论 内镜超声检查能较清楚地显示食管壁的5层结构，比较准确地判断隆起性病变与食管壁的关系，对食管隆起性病变的诊断、鉴别诊断和指导治疗均有很大价值。     

Lymphatic metastases to the esophagus

The authors present 4 cases of esophageal involvement by lymphatic spread of tumors originating in the stomach, distal esophagus, and thyroid. Double-contrast radiographs of the esophagus showed discontinuous submucosal extension and multiple polypoid masses.     

PillCam ESO in esophageal studies: improved diagnostic yield of 14 frames per second (fps) compared with 4 fps

BACKGROUND AND STUDY AIM: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD) lesions. We tested a new device which produces images at a rate of 14 fps. The diagnostic performance and esophageal visualization of these two devices were compared. PATIENTS AND METHODS: 42 patients with GERD symptoms and eight patients with a history of Barrett's esophagus had an esophagogastroduodenoscopy (EGD). All patients underwent capsule endoscopy of the esophagus within 1 hour prior to EGD. The first 25 patients had a capsule endoscopy examination with the 4-fps device. The following 25 patients underwent capsule endoscopy under identical conditions but using the 14-fps device. The reader of the capsule endoscopy study was blinded to the EGD findings. A diagnosis of GERD or Barrett's esophagus was established with EGD. The findings at capsule endoscopy were compared with the EGD findings. We also examined how frequently the esophagus in its entirety was visualized by these two devices. RESULTS: The 4-fps device diagnosed 16/19 cases of esophageal erosions or ulcers (sensitivity 84 %) and 6/8 cases of Barrett's esophagus (sensitivity 75 %). The 14-fps capsule diagnosed 16/16 cases of esophageal ulcers or erosions and 7/7 cases of Barrett's esophagus (sensitivity 100 %). The total diagnostic miss rate in the 4-fps group was 5/27 (18 %) whereas the diagnostic miss rate in the 14-fps group was 0/23 (0 %) P < 0.02). The upper esophageal sphincter (UES) was clearly identified in 6/25 patients (24 %) in the 4-fps group and in 20/25 patients (80 %) in the 14-fps group ( P < 0.01). The entire esophagus was well visualized in 3/25 patients (12 %) by the 4-fps device and in 19/25 (76 %) by the 14-fps device ( P < 0.01). The superiority of the 14-fps PillCam ESO capsule is consistent with the data obtained from fluoroscopic studies of swallowed PillCam capsules, showing that capsule speed may reach 20 cm/s. For the 14-fps PillCam this means one image transmitted per 3-cm segment at maximal capsule speed, therefore still allowing for full visualization of the entire esophagus. CONCLUSIONS: Capsule endoscopy using the 14-fps PillCam ESO showed a greater sensitivity than that of the 4-fps device for identifying GERD. The 14-fps PillCam ESO was statistically superior to the 4-fps device in visualizing the opening of the UES and the entirety of the esophagus.     

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。     

Primary and secondary malignancies of the penis: ultrasound features

Cancer of the penis is a rare neoplasm in developed countries but worldwide represents a significant health problem. In this study, the ultrasonographic features of primary and secondary malignant lesions of the penis are described. Squamous cell carcinoma usually presents as a hypoechoic lesion with heterogeneous appearance. Invasions of the corpora cavernosa and the corpus spongiosum are appreciable. B-cell lymphoma presents as well-vascularized mass, a plaque, or ulcers in the penile skin. Penile metastases results from hematogenous or lymphatic spreading of distant tumors or, more frequently, as penile infiltration by tumors from adjacent organs. Diffuse corporeal or nodular involvement can result.     

24h食管pH监测和食管测压及奥美拉唑治疗试验在食管原性胸痛中的应用

目的 :探讨 2 4 h食管 p H监测和食管测压及奥美拉唑治疗试验在食管原性胸痛中的诊断价值。方法 :对食管原性胸痛 6 8例行内镜、食管测压、2 4 h食管 p H监测及 7d的奥美拉唑 (2 0 mg,2次 / d)治疗试验 ,治疗后症状评分比治疗前降低超过 75 %者则为治疗试验阳性。结果 :食管原性胸痛 6 8例中 5 5例 (81% )符合胃食管反流病 (GERD) ,胡桃夹食管 2例 ,早期贲门失驰缓症 3例 ,弥漫性食管痉挛 3例 ,无效食管运动 (IEM) 5例。GERD5 2例测压分析 ,35例(6 7% )符合 IEM诊断标准。奥美拉唑治疗试验对诊断 GERD的敏感性为 93% ,特异性为 85 %。结论 :GERD是食管原性胸痛的主要原因。 2 4 h食管 p H监测和食管测压是诊断食管原性胸痛的主要检查手段 ,奥美拉唑治疗试验是临床诊断GERD简便而实用的方法。     

食管入口病变的X线钡剂和CT检查及其临床意义

目的：分析食管入口病变的临床以及X线和CT表现,探讨食管入口病变的影像学检查方法,以提高食管入口病变的影像学诊断水平。方法：回顾分析34例经临床、手术、穿刺和病理证实的食管入口病变患者的临床和影像学资料。34例均行CT检查,其中27例行增强前后CT扫描,7例仅行CT平扫。34例中有28例行X线钡剂检查。结果：34例食管入口病变包括原发于食管入口的肿瘤14例（鳞癌12例、未分化癌2例）、食管入口括约肌肥厚3例、食管入口憩室5例、食管入口损伤12例。34例食管入口病变均有吞咽障碍的临床症状,食管入口癌的中晚期,吞钡检查可见食管入口黏膜破坏。肿瘤早期CT表现不明显,中晚期病人食管入口壁可有不规则增厚或肿块。环咽肌肥厚者,CT表现为食管壁局部增厚,黏膜光滑。食管入口憩室者,CT表现为食管入口侧壁不强化的软组织肿块,吞钡可见食管一侧囊袋状龛影,有钡剂进入。食管入口破裂者吞钡时,可见钡剂溢入颈部软组织,2例食管入口破裂、穿孔并发纵膈脓肿者CT可见上纵膈增宽,增强扫描后见低密度脓腔。结论：X线钡剂检查对食管入口病变的诊断,目前仍有不可替代的作用,它简便易行、费用低廉、易被患者接受。CT对食管入口肿瘤的定性、分期,对食管入口损伤及其并发症的观察有重要意义,若将两者结合起来,能提高食管入口病变的影像学诊断水平。     

Skeletal muscle metastasis with bone metaplasia from colon cancer: A case report and review of the literature

BACKGROUNDColon cancer is a common malignant disease of the gastrointestinal tract and usually occurs at the junction of the rectum and sigmoid colon. Lymphatic and hematogenous metastases occur frequently in colon cancer and the most common metastatic sites include the liver, lung, peritoneum, bone, and lymph nodes. As a manifestation of advanced tumor spread and metastasis, soft tissue metastasis, especially skeletal muscle metastasis with bone metaplasia caused by colon cancer, is rare, accounting for less than 1% of metastases. CASE SUMMARYA 43-year-old male patient developed skeletal muscle metastasis with bone metaplasia of the right proximal thigh 5 mo after colon cancer was diagnosed. The patient was admitted to the hospital because of pain caused by a local mass on his right thigh. Positron emission tomography-computed tomography showed many enlarged lymph nodes around the abdominal aorta but no signs of lung or liver metastases. Color ultrasound revealed a mass located in the skeletal muscle and the results of histological biopsy revealed a poorly differentiated adenocarcinoma suspected to be distant metastases from colon cancer. Immunohistochemistry showed small woven bone components that were considered to be ossified.CONCLUSIONThis case reminds us that for patients with advanced colorectal tumors, we should be alert to the possibility of unconventional metastasis.     

Usefulness of MDCT evaluation of the intraluminal surface of esophageal masses using only effervescent powder without injection of hypotonic agent

This study evaluated the inner surface of esophageal masses using multidetector computed tomography (MDCT) after esophageal distention with an ingested effervescent powder without inducing pharmacological esophageal hypotonia. From September 2004 to December 2005, 38 patients underwent MDCT after esophageal distention using only an effervescent powder that was ingested only 35 s after injecting the contrast agent and twice 50 s after the injection. Ten patients had a normal esophagus and twenty-eight patients had an esophageal mass detected by endoscopy. The degree of distention at three levels (upper, middle, and lower) and the intraluminal surface of the esophageal mass were evaluated. The surface between the normal and esophageal mass were analyzed using an ANOVA test. Esophageal distention in the upper and middle thirds was classified as either “good” or “fair” in 90.8% of cases. In the lower third, 81.6% of cases were either “good” or “fair”. All esophageal cancers had an irregular surface but all normal lining and benign esophageal masses had a smooth surface. MDCT after esophageal distention using the effervescent powder ingested twice achieved good-to-fair distention in the esophagus, and is a useful diagnostic modality for identifying the intraluminal surface of esophageal masses.     

Esophageal intramural metastasis from adenocarcinoma of the gastroesophageal junction

Among a total of 143 patients examined for diagnosis of adenocarcinoma of the cardia, intramural esophageal metastases were verified in six patients (4.19 %). In each case the diagnosis was confirmed by histological examination. The histological structure of the primary tumors and metastases was the same. Metastases were detected by endoscopic ultrasound examination in three cases. All the cardia tumors proved to be well advanced. As well as endoscopic identification of the primary tumor, thorough examination of the proximal part of the esophagus is of great importance.