Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement

AIM:To investigate the capacity for 18F-fluorodeoxyglucose(18F-FDG) positron emission tomography(PET) to evaluate patients with gastrointestinal lesions of follicular lymphoma.METHODS:This retrospective case series consisted of 41 patients with follicular lymphoma and gastrointestinal involvement who underwent 18F-FDG-PET and endoscopic evaluations at ten different institutions between November 1996 and October 2011.Data for endoscopic,radiological,and biological examinations performed were retrospectively reviewed from clinical records.A semi-quantitative analysis of 18F-FDG uptake was performed for each involved area by calculating the maximum standardized uptake value(SUVmax).Based on the positivity of 18F-FDG uptake in the gastrointestinal lesions analyzed,patients were subdivided into two groups.To identify potential predictive factors for 18F-FDG positivity,these two groups were compared with respect to gender,age at diagnosis of lymphoma,histopathological grade,pattern of follicular dendritic cells,mitotic rate,clinical stage,soluble interleukin-2 receptor levels detected by 18F-FDG-PET,lactate dehydrogenase(LDH) levels,hemoglobin levels,bone marrow involvement,detectability of gastrointestinal lesions by computed tomography(CT) scanning,and follicular lymphoma international prognostic index(FLIPI) risk.RESULTS:Involvement of follicular lymphoma in the stomach,duodenum,jejunum,ileum,cecum,colon,and rectum was identified in 1,34,6,3,2,3,and 6 patients,respectively.No patient had esophageal involvement.In total,19/41(46.3%) patients exhibited true-positive 18F-FDG uptake in the lesions present in their gastrointestinal tract.In contrast,false-negative 18F-FDG uptake was detected in 24 patients(58.5%),while false-positive 18F-FDG uptake was detected in 5 patients(12.2%).In the former case,2/19 patients had both 18F-FDG-positive lesions and 18F-FDGnegative lesions in the gastrointestinal tract.In patients with 18F-FDG avidity,the SUVmax value of the involved gastrointestinal tract ranged from 2.6 to 17.4(median:4.7).For the 18F-FDG-negative(n = 22) and-positive(n = 19) groups,there were no differences in the male to female ratios(10/12 vs 4/15,P = 0.186),patient age(63.6 ± 2.4 years vs 60.1 ± 2.6 years,P = 0.323),presence of histopathological grade 1 vs 2(20/2 and 17/2,P = 1.000),follicular dendritic cell pattern(duodenal/nodal:13/5 vs 10/3,P = 1.000),mitotic rate(low/partly high,14/1 vs 10/3,P = 0.311),clinical stage according to the Ann Arbor system(stages ⅠE and ⅡE/other,15/7 vs 15/4,P = 0.499),clinical stage according to the Lugano system(stages Ⅰ and Ⅱ-1/other,14/8 vs 14/5,P = 0.489),soluble interleukin-2 receptor levels(495 ± 78 vs 402 ± 83,P = 0.884),LDH levels(188 ± 7 vs 183 ± 8,P = 0.749),hemoglobin levels(13.5 ± 0.3 vs 12.8 ± 0.4,P = 0.197),bone marrow involvement(positive/negative,1/8 vs 1/10,P = 1.000),detectability by CT scanning(positive/negative,1/16 vs 4/13,P = 0.335),and FLIPI risk(low risk/other,16/6 vs 13/6,P = 0.763),respectively in each case.CONCLUSION:These findings indicate that it is not feasible to predict 18F-FDG-avidity.Therefore,18FFDG-PET scans represent a complementary modality for the detection of gastrointestinal involvements in follicular lymphoma patients,and surveillance of the entire gastrointestinal tract by endoscopic examinations is required.     

胶囊内镜与双气囊内镜诊断小肠疾病的比较

目的比较胶囊内镜和双气囊内镜对小肠疾病的检出率和诊断准确性，探讨其联合应用的临床意义。方法对116例不明原因消化道出血和102例不明原因腹痛或腹泻患者，共218例进行内镜检查。其中165例首选胶囊内镜，53例首选双气囊内镜。对胶囊内镜检查阴性或可疑病变者建议双气囊内镜检查，反之亦然。比较两种检查方法对小肠疾病的检出率、诊断率以及患者依从性、不良反应发生率等。结果1例胶囊内镜和2例双气囊内镜操作失败。51例患者行64次双气囊内镜检查，其中34例经口、4例经肛检查，13例分别接受经口和经肛检查。胶囊内镜对小肠病变的总检出率及对不明原因消化道出血的小肠疾病检出率（72．0％和88．0％），均明显高于双气囊内镜（41．2％和60．0％），诊断率也高于后者（51．8％和39．2％）。5例胶囊内镜检查阴性再经双气囊内镜检查者中，1例发现病灶；15例胶囊内镜检查怀疑小肠病变者中，12例经双气囊内镜结合活检病理确诊。而3例双气囊内镜未发现异常者再经胶囊内镜检查发现小肠病变。所有患者均未发生严重不良反应。结论胶囊内镜对小肠疾病检出率高，可作为怀疑小肠疾病，尤其是不明原因消化道出血的首选检查方法；双气囊内镜在胶囊内镜检查阴性者中仍可发现部分病灶，并能明确多数胶囊内镜下可疑病变，可作为胶囊内镜检查后的补充检测手段。     

胶囊内镜序贯联合双气囊小肠镜诊断小肠出血

目的评价胶囊内镜(capsule endoscopy,CE)序贯联合双气囊小肠镜(double-balloon enteroscopy,DBE)检查对小肠出血疾病(small intestine bleeding,SIB)的临床诊断价值。方法回顾性分析106例行CE检查及部分序贯联合DBE检查SIB患者的临床资料。结果 106例SIB患者病因明确诊断率为96.2%(102/106),以肠黏膜糜烂、溃疡性病变25.5%(27/106)、血管病变24.5%(26/106)、小肠肿瘤、隆起病变23.6%(25/106)最常见;行CE和DBE检查的病变检出率分别为89.6%(95/106)、96.2%(50/52),病因诊断率分别为50.9%(54/106)、92.3%(48/52),DBE检查病因诊断率显著高于CE检查,差异有统计学意义(P0.01);CE和DBE检查发现血管病变、肿瘤隆起病变与憩室分别为22.6%(24/106)、0.9%(1/106)和51.9%(27/52)、15.4%(8/52),DBE对血管病变、肿瘤隆起病变与憩室病因的诊断率高于CE,二者比较差异有统计学意义(P0.05)。结论在小肠出血患者中CE检查对血管病变、肿瘤隆起病变与憩室的病因诊断低于DBE检查;CE序贯联合DBE检查应用能提高小肠出血疾病的病变检出率及病因诊断率。     

双气囊小肠镜与胶囊内镜在小肠出血应用中的对比研究

目的比较双气囊小肠镜与胶囊内镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,初步探讨双气囊小肠镜对小肠出血的内镜下治疗。方法2006年4月至2009年10月烟台毓璜顶医院消化内科收治的可疑小肠出血患者159例,其中81例患者行双气囊小肠镜检查,首选进镜方式分为经口或经肛2种,首选方式检查后未发现病灶者,日后改换进镜方式再行检查。对活动性出血病灶行内镜下止血治疗。另78例患者行胶囊内镜检查。两组患者分别由专门医师独立操作并诊断,最后进行汇总分析,对比双气囊小肠镜与胶囊内镜的临床应用价值。结果双气囊小肠镜组的病变检出率为95.06%,病因诊断率为82.72%,23例检查时见病变活动性出血,行内镜下止血治疗,21例止血成功,内镜止血成功率为91.30%;胶囊内镜组的病变检出率82.05%,病因诊断率为66.67%。双气囊小肠镜组的病因检出率及病因诊断率均显著高于胶囊内镜组,差异有统计学意义(P0.05)。在耐受性方面,胶囊内镜的耐受性最好,双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜。所有患者均未发生严重并发症。结论双气囊小肠镜对小肠出血的病因诊断明显优于胶囊内镜,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法。     

18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) does not visualize follicular lymphoma of the duodenum

<p>18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has been used as a potential tool for imaging nodal follicular lymphoma (FL) and extranodal spread. As primary intestinal FL is increasingly being recognized, we have performed a study to investigate the usefulness of 18F-FDG-PET for staging of extranodal FL within the gastrointestinal tract. In eight patients with a diagnosis of FL localized in the duodenum (six cases in stage I and one each in stages II and IV, respectively) whole body 18F-FDG-PET scans were performed. Seven patients with duodenal FL were rated WHO grade 1 and one had FL grade 3, while both patients with secondary spread had FL WHO grade 1. All patients were imaged before initiation of therapy. None of the patients with primary duodenal FL showed pathologically elevated 18F-FDG uptake. 18F-FDG-PET findings were not influenced by histological grade or proliferative activity of FL. These findings suggest that 18F-FDG-PET is not useful for clinical assessment of primary duodenal FL.     

Double-Balloon Enteroscopy and Small Bowel Tumors: A South-European Single-Center Experience

Small bowel tumors are rare, accounting for 1–2% of all gastrointestinal neoplasms. We sought to determine the diagnostic and therapeutic impact of double-balloon enteroscopy (DBE) in patients with small bowel tumors. Between January 2005 and March 2008, 78 patients underwent 96 DBE. All nine patients (seven males; mean age 68 ± 11.3 years) with small bowel tumors were retrospectively reviewed. Clinical presentation was: mid-gastrointestinal bleeding or iron-deficient anemia (55.6%); abdominal pain (22.2%); nausea/vomiting and abdominal distension (22.2%). Five patients had abnormal findings in previous capsule endoscopy and four in previous radiologic examinations. Route of insertion was exclusively oral and abnormal lesions were detected in all patients (jejunum 8; ileum 1). Biopsies were taken in seven patients and provided definitive histological diagnosis in all except one. There were no complications of DBE. Surgical resection took place in eight patients. Final histologic diagnosis were: primary carcinoma (33.3%), gastrointestinal stromal tumor (GIST) (33.3%), malignant lymphoma (22.2%), and carcinoid tumor (11.1%). Mean follow-up time was 15.4 ± 12.7 months (range 2–34 months). Six patients were submitted to chemotherapy. Two patients died. Small bowel tumors are common in patients submitted to DBE. Given its safety and diagnostic capabilities, DBE should be considered the gold-standard method in the study of these neoplasms.     

Double-balloon enteroscopy reliably directs surgical intervention for patients with small intestinal bleeding

AIM： To evaluate preoperative double-balloon enteroscopy for determining bleeding lesions of small intestine, thus directing selective surgical intervention. METHODS： We retrospectively reviewed 56 patients who underwent double-balloon enteroscopy to localize intestinal bleeding prior to surgical intervention, and compared enteroscopic findings with those of intraoperation to determine the accuracy of enteroscopy in identifying and localizing the sites of small intestinal bleeding. RESULTS： Double-balloon enteroscopy was performed in all 56 patients in a 30-mo period. A possible site of blood loss was identified in 54 （96%） patients. Enteroscopy provided accurate localization of the bleeding in 53 （95%） of 56 patients, but failed to disclose the cause of bleeding in 4 （7%）. There was one case with negative intraoperative finding （2%）. Resection of the affected bowel was carried out except one patient who experienced rebleeding after operation. Gastrointestinal stromal tumor （GIST） was most frequently diagnosed （55%）. CONCLUSION： Double-balloon enteroscopy is a safe, reliable modality for determining bleeding lesion of small intestine. This technique can be used to direct selective surgical intervention.     

Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases

AIM: To compare the roles of capsule endoscopy(CE)and double-balloon enteroscopy(DBE) in the diagnosis of obscure small bowel diseases.METHODS: From June 2009 to December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions,fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into:(1) the definite diagnosis(the diagnosis was confirmed at least by one of the biopsy,surgery, pathology or the drug treatment effects with follow-up for at least 3 mo);(2) the possible diagnosis(a possible diagnosis was suggested by CE or DBE,but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and(3) the unclear diagnosis(no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. The differencein the etiologies between CE and DBE was estimated,and the different possible etiologies caused by the age groups were also investigated.RESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers(P = 0.242, Fisher's test), and small vascular malformations(χ 2 = 1.810,P = 0.179, Pearson χ 2 test), but with no significant differences, possible due to few cases. However,DBE was better than CE for larger tumors(P =0.018, Fisher's test) and for diverticular lesions with bleeding ulcers(P = 0.005, Fisher's test). All three hemangioma cases diagnosed by DBE in this study(including sponge hemangioma, venous hemangioma,and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates(DR) of CE(60.0%, 53/88) and DBE(59.1%, 52/88). However,the etiological diagnostic yield(DY) difference was apparent. The CE diagnostic yield was 42.0%(37/88),and the DBE diagnostic yield was 51.1%(45/88).Furthermore, there were differences among the age groups(χ 2 = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer(5/6 cases), vascular malformations(22/29 cases), and active bleeding(3/4cases) appeared more commonly in the patients over50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group(4/7cases). The over-25-year group accounted for the stromal tumors(10/12 cases).CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient's age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary.     

胶囊内镜指导双气囊内镜进镜方式的临床研究

目的评估小肠疾病诊治中胶囊内镜（CE）对双气囊内镜（DBE）进镜方式的预测作用。方法将CE完成全小肠检查且其诊断经DBE证实者纳入研究。CE检出病灶的部位以时间指数（胶囊从幽门至病灶的通过时间占胶囊从幽门至回盲瓣通过时间的比例）表示,根据以往回顾性分析的结果采用0．6作为时间指数的临界值,时间指数不超过0．6时选择经口DBE检查,反之选择经肛检查。对最终结果进行统计学分析,评估根据病灶部位cE时间指数选择DBE进镜方式的准确性。结果最终共60例患者CE完成全小肠检查且其诊断经DBE证实而纳入研究。共行60例次DBE检查,包括41例经口和19例经肛检查,所有患者CE检出病灶均经首次DBE检查证实。对所得结果进行统计显示,根据cE时间指数临界值0．6,本组患者DBE进镜方式选择的准确性为100％。结论DBE是一项有效地证实CE诊断的方法,在cE完成全小肠检查者中根据CE时间指数能够准确判断DBE的进镜方式。     

Small bowel enteroscopy

Over the past decade, the advent of capsule endoscopy and balloon-assisted enteroscopy has revolutionized the approach to small intestinal diseases. The small bowel is no longer out of reach, and has fallen within the diagnostic and therapeutic realm of the gastrointestinal endoscopist. Double-balloon enteroscopy was the first type of balloon-assisted endoscopy and is the method for which there are the most data. Single-balloon enteroscopy has since been introduced as an alternative balloon-assisted method, followed more recently by the development of spiral overtube-assisted enteroscopy. The purpose of the present article is to review these methods of small bowel enteroscopy and to discuss the latest developments. While the investigation of small bowel diseases cannot be addressed without considering the central role of capsule endoscopy, a detailed assessment is beyond the scope of the present article, and capsule endoscopy will only be discussed as it pertains to enteroscopy.     

Double-balloon enteroscopy for mesenchymal tumors of small bowel:Nine years’ experience

AIM:To assess the value of double-balloon enteroscopy(DBE) for the diagnosis of gastrointestinal mesenchymal tumors(GIMTs) in the small bowel and clarify their clinical and endoscopic characteristics.METHODS:A retrospective review in a total of 783 patients who underwent a DBE procedure from January 2003 to December 2011 was conducted.Data from patients with pathologically confirmed GIMTs were analyzed at a single tertiary center with nine years’ experience.The primary outcomes assessed included characteristics of patients with GIMTs,indications for DBE,overall diagnostic yield of GIMTs,endoscopic morphology,positive biopsy,comparison of diagnosis with capsule endoscopy,and subsequent interventional management.RESULTS:GIMTs were identified and analyzed in 77 patients.The mean age was 47.74 ± 14.14 years(range:20-77 years),with 63.6% being males.The majority of individuals presented with gastrointestinal bleeding,accounting for 81.8%,followed by abdominal pain,accounting for 10.4%.Small bowel pathologies were found in 71 patients,the detection rate was 92.2%.The diagnostic yield of DBE for GIMTs was 88.3%.DBE was superior to capsule endoscopy in the diagnosis of GIMTs(P = 0.006;McNemar’s χ2 test).Gastrointestinal stromal tumor was the most frequent and leiomyoma was the second frequent GIMT.Single and focal lesions were typical of GIMTs,and masses with smooth or unsmooth surface were the most common in the small bowel.GIMTs were removed from all the patients surgically except one patient treated with endoscopic resection.CONCLUSION:DBE is a safe and valuable procedure for patients with suspected GIMTs,and it provides an accurate position for subsequent surgical intervention.     

Diagnosis of the jejunoileal lymphoma by double-balloon endoscopy

AIM: To investigate the feasibility of double-balloon endoscopy (DBE) to detect jejunoileal lymphoma, compared with fluorodeoxyglucose positron emission tomography (FDG-PET).METHODS: Between March 2004 and January 2011, we histologically confirmed involvement of malignant lymphoma of the jejunoileum in 31 patients by DBE and biopsy. In 20 patients of them, we performed with FDG-PET. We retrospectively reviewed the records of these 20 patients. Their median age was 64 years (range 50-81). In the 20 patients, the pathological diagnosis of underlying non-Hodgkin’s lymphoma (NHL) comprised follicular lymphoma (FL, n = 12), diffuse large B cell lymphoma (DLBCL, n = 4), mantle cell lymphoma (MCL, n = 2), enteropathy associated T cell lymphoma (ETL, n = 1) and anaplastic large cell lymphoma (ALCL, n = 1).RESULTS: Ten cases showed accumulation by FDG-PET (50%). FDG-PET was positive in 3 of 12 FL cases (25%) while in 7 of 8 non-FL cases (88%, P < 0.05). Intestinal FL showed a significantly lower rate of positive FDG-PET, in comparison with other types of lymphoma. Cases with endoscopically elevated lesions (n = 10) showed positive FDG-PET in 2 (20%), but those with other type NHL did in 8 of 10 (80%, P < 0.05). When the cases having elevated type was compared with those not having elevated type lesion, the number of cases that showed accumulation of FDG was significantly smaller in the former than in the latter.CONCLUSION: In a significant proportion, small intestinal involvement cannot be pointed out by FDG-PET. Especially, FL is difficult to evaluate by FDG-PET but essentially requires DBE.     

Malignant lymphoma in the ileum diagnosed by double-balloon enteroscopy

A 73-year old man presented with abdominal pain. A tumor with central ulceration was observed in the ileum using double-balloon enteroscopy. Histological findings of the biopsy specimens were consistent with malignant lymphoma. Double-balloon enteroscopy confirmed the diagnosis of a malignant lymphoma tumor which was surgically resected. The patient is still in complete remission now.     

Clinical outcomes of enteroscopy using the double-balloon method for strictures of the small intestine

AIM:To evaluate the clinical outcome of enteroscopy, using the double-balloon method, focusing on the involvement of neoplasms in strictures of the small intestine. METHODS: Enteroscopy, using the double-balloon method, was performed between December 1999 and December 2002 at Jichi Medical School Hospital, 3apan and strictures of the small intestine were found in 17 out of 62 patients. These 17 consecutive patients were subjected to analysis. RESULTS: The double-balloon enteroscopy contributed to the diagnosis of small intestinal neoplasms found in 3 out of 17 patients by direct observation of the strictures as well as biopsy sampling. Surgical procedures were chosen for these three patients, while balloon dilation was chosen for the strictures in four patients diagnosed with inflammation without involvement of neoplasm. CONCLUSION: Double-balloon enteroscopy is a useful method for the diagnosis and treatment of strictures in the small bowel.     

胶囊内镜与双气囊小肠镜对小肠疾病诊断的荟萃分析

目的比较胶囊内镜和双气囊小肠镜对小肠疾病的阳性检出率。方法从Medline、Embase、Elsevier Science Direct和中国期刊全文数据库中检索比较胶囊内镜和双气囊小肠镜对小肠疾病阳性检出率的前瞻性研究。对各项研究中2种内镜的阳性检出率比数比（OR）行荟萃分析，经异质性检验后采用固定效应模型或随机效应模型进行统计分析。并根据可能产生异质性的原因进行分层分析。结果共有8项研究入选（n=277）。荟萃结果表明，胶囊内镜和双气囊小肠镜对小肠疾病阳性检出率没有显著差别[170／277比156／277，随机效应模式：OR为1．21（95％可信区间CI：0．64，2．29）]。分层分析提示：胶囊内镜的阳性率显著高于未采用经口和经肛这2种进镜方式相结合的双气囊小肠镜[137／219比110／219，固定效应模式：OR为1．67（95％CI：1．14，2．44），（P〈0．01）]；而低于用这2种进镜方式相结合的双气囊小肠镜检查，但差异没有统计学意义[26／48比37／48，随机效应模式：OR0．33（95％CI：0．05，2．21），（P〉0．05）]。进一步对5项全文发表的关于对不明原因消化道出血诊断的研究进行荟萃，结果仍然提示胶囊内镜的阳性检出率明显高于未采用经口和经肛这2种进镜方式相结合的双气囊小肠镜[118／191比96／191，固定效应模式：OR1．61（95％CI：1．07，2．43），（P〈0．05）]，但显著低于2种进镜方式相结合的双气囊小肠镜检查[11／24比21／24，固定效应模式：OR0．12（95％CI：0．03，0．52），（P〈0．01）]。结论双气囊小肠镜经口和经肛2种进镜方式联合应用的阳性率可能高于胶囊内镜，对这2种内镜的选择，应该取决于病人的一般状况及其意愿，医疗单位所具备的能力，以及病灶是否可能需要采取进一步的介入治疗。     

Primary intestinal follicular lymphoma:How to identify follicular lymphoma by routine endoscopy

A 69-year-old Japanese female was diagnosed with primary intestinal follicular lymphoma. Esophagogas-troduodenoscopy with high-definition imaging revealed not only the typical feature of whitish polyps of up to 2 mm in diameter in the duodenal second and third portions, but also more detailed morphology, such as enlarged whitish villi and tiny whitish depositions. These findings appeared to reflect the pathological structures; infiltration of lymphoma cells into the villi were probably seen as enlargement of the villi, and the formation of lymphoid follicles were shown as opaque white spots or tiny white depositions. Thus, the above features might contribute to the distinct diagnosis of intestinal follicular lymphoma. This case indicates that routine esophagogastroduodenoscopy can visualize microsurface structures, which can be pathognomonic and help to diagnose intestinal follicular lymphoma, even without magnifying endoscopy.     

Positron emission tomography computed tomography features of monomorphic epitheliotropic intestinal T-cell lymphoma

Objective: To define the positron emission tomography/computed tomography (PET/CT) features of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), a rare malignancy in European and North American populations and the most common form of primary intestinal T-cell lymphoma in Asian populations.

Methods: ¹⁸F-fluorodeoxyglucose (FDG) PET/CT findings of a cohort of MEITL patients were retrospectively analyzed.

Results: Eight men and four women with MEITL investigated by PET/CT at diagnosis and relapse were retrospectively analyzed. On presentation, the primary involved sites were the small bowel (N?=?8), large bowel (N?=?2), stomach (N?=?1) and small and large bowels (N?=?1). The uninvolved small bowel did not show increased FDG-avidity to suggest enteropathy. On presentation, lymph nodes and other organs were involved in seven cases (58%). The primary lesions were hypermetabolic except in one case, where the colonic lesion was eumetabolic. At relapse, the stomach and large bowel might be involved even if the primary tumours arose from the small bowel, and multiple extra-intestinal metastases occurred. Interestingly, thoracic structures and the brain were frequently involved (50% and 25% respectively).

Conclusion: These findings showed that in contrast to classical enteropathy-associated T-cell lymphoma, where the small bowel is the exclusive primary site (owing to its origin from coeliac disease) and distant metastases even during relapse are exceptional, MEITL might on presentation and during relapse involve any part of the gut, and metastasize to multiple extra-intestinal sites.     

Double-balloon enteroscopy in small bowel tumors: A Chinese single-center study

AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be consider     

胶囊内镜结合双气囊内镜检查在小肠疾病诊断中的作用

目的 探讨胶囊内镜结合双气囊内镜检查在小肠疾病诊断中的作用.方法 连续调查299例因不明原因消化道出血或腹痛、腹泻等原因而行胶囊内镜检查者,对胶囊内镜阴性或诊断不确定者建议双气囊内镜检查.分析胶囊内镜后双气囊内镜检查者诊断和随访资料.结果 296例完成胶囊内镜检查,发现阳性138例(46.6%),可疑阳性68例(23.0%),阴性90例(30.4%).45例胶囊内镜可疑阳性者和7例阴性者接受双气囊内镜检查,分别检出31例和1例小肠病变.双气囊内镜可能存在假阴性结果8例,未发现假阳性者;胶囊内镜可能存在假阴性结果2例,并有8例假阳性.在胶囊内镜结果提示下,90.3%(28/31)患者经单侧双气囊内镜检查即发现病灶.平均随访期为17个月,93.5%的双气囊内镜明确诊断者得到有效治疗.二种检查方法耐受性好,无严重不良反应发生.结论 胶囊内镜对小肠病变检出率高,但其诊断不确定性也较高.双气囊内镜能明确大部分胶囊内镜可疑阳性者.胶囊内镜结合双气囊内镜检查的诊断策略能提高小肠疾病诊断率、指导治疗并改善患者预后.     

Fluorine-18 fluorodeoxyglucose positron emission tomography in mature T-cell and natural killer cell malignancies

Fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) is useful in Hodgkin and B-cell lymphomas. Few data exist on T-cell and natural killer (NK)-cell lymphomas. Thirty consecutive T-cell and NK-cell lymphomas were investigated with PET-computerized tomography (CT). In 12 NK-cell lymphomas, all nasal/extranasal lesions were FDG-avid. In nasal/maxillary areas, FDG-avid tumours were consistently more localised than on CT, suggesting that soft tissue masses on CT were partly due to inflammation. These findings have important implications in radiotherapy planning. In two NK-cell lymphomas, PET did not detect morphologically occult marrow infiltration uncovered by in situ hybridisation for Epstein-Barr-virus-encoded small RNA. In angioimmunoblastic lymphoma (n = 7), peripheral T-cell lymphoma, unspecified (PTCL-U, n = 4) and anaplastic large cell lymphoma (ALCL, n = 3), involved nodal/extranodal sites shown on CT and/or biopsy were concordantly PET-positive. In one PTCL-U, PET detected FDG-avid marrow infiltrations not shown on biopsies. In contrast, cutaneous ALCL (n = 1) and mycosis fungoides (n = 2) showed minimal FDG uptake. In one case of T-cell large granular lymphocyte leukaemia, marrow, nodal and bowel infiltrations were not FDG-avid. PET maximum standardised uptake value did not correlate with clinicopathological features and prognosis. These observations defined the pre-treatment value of PET-CT in T-cell and NK-cell lymphomas. The post-treatment role requires further studies.