A 39-year-old man presented with dizziness and melena for 2 months. Abdominal CT scan showed constrictive wall thickening with enhancement and proximal loop dilatation of the jejunum. On endoscopic examination, there was large amount of bile stained fluid in duodenum. Enteroscopy using pediatric colonoscope demonstrated an encircling mass with obstruction approximately 20 cm distal to the ligament of Treitz. Endoscopic jejunal biopsy showed moderately differentiated adenocarcinoma. Small intestinal adenocarcinoma is uncommonly encountered in clinical practice. Because small intestine is relatively inaccessible via routine endoscopy, diagnosis of small intestinal neoplasm is often delayed for several months after the onset of symptoms. Most of the patients are diagnosed in advanced stage. Therefore, when a small bowel neoplasm is suspected, enteroscopy is the most useful study. If enteroscope is not available, enteroscopy using pediatric colonoscope may permit earlier preoperative diagnosis. We report a case of primary jejunal adenocarcinoma diagnosed by endoscopic biopsy using pediatric colonoscope.
Adenocarcinoma/*pathology/radiography/surgery ; Adult ; Colonoscopes ; Endoscopy, Gastrointestinal ; Humans ; Jejunal Neoplasms/*pathology/radiography/surgery ; Male

Hepatocellular carcinoma (HCC) rarely invades the gastrointestinal (GI) tract. It occurs in 0.7% to 2% of clinical HCC cases. Moreover, gastric invasion with GI hemorrhage via peritoneal seeding is very rare. We report the case of 67-year-old woman who had a history of HCC rupture and was admitted due to left upper quadrant abdominal pain. The patient was diagnosed with three omental metastatic masses and underwent hepatic segmentectomy and omental tumorectomy. Two months later, the patient had massive melena, and an esophagogastroduodenoscopy showed very large ulcerated friable mass on the gastric body. The histology was consistent with the diagnosis of metastatic HCC. The patient died from persistent GI hemorrhage 93 days after the admission. This case illustrates the very rare event of peritoneal seeding of a ruptured HCC causing direct invasion of the stomach, followed by GI hemorrhage.
Aged ; Carcinoma, Hepatocellular/*diagnosis/radiography/secondary ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology/radiography ; Gastroscopy ; Humans ; Liver Neoplasms/*diagnosis/pathology/radiography ; *Neoplasm Seeding ; Peritoneal Neoplasms/*diagnosis/radiography/secondary ; Stomach Neoplasms/*diagnosis/radiography/secondary ; Tomography, X-Ray Computed

Follicular dendritic cell sarcoma is a rare malignant neoplasm and little is known about its radiological features. We present here four cases of follicular dendritic cell sarcomas and we provide the image characteristics of these tumors to help radiologists recognize this entity when making a diagnosis.
Adult ; Dendritic Cell Sarcoma, Follicular/pathology/*radiography ; Diagnosis, Differential ; Female ; Gastrointestinal Neoplasms/radiography ; Head and Neck Neoplasms/pathology/radiography ; Humans ; Male ; Mediastinal Neoplasms/radiography ; Middle Aged ; Tomography, X-Ray Computed

Brunnera's gland hyperplasia is a benign tumor of the duodenum and it is rarely associated with clinical symptoms. We report on a 64-yr-old man with Brunnera's gland hyperplasia who had undergone a duodenocephalo-pancreatectomy. The reason is that he presented upper gastrointestinal obstructive symptoms and the esophagogastroduodenoscopic finding revealed the lesion to be an infiltrating type mass on the second portion of the duodenum with luminal narrowing. An abdominal computed tomography showed a 2.5 cm-sized mass in the duodenal second portion with a suspicious pancreatic invasion and 7 mm-sized lymph node around the duodenum. Duodenocephalopancreatectomy was successfully performed. Histological examination revealed a Brunnera's gland hyperplasia. The final diagnosis was the coexistence of Brunnera's gland hyperplasia and pancreatic heterotopia with a pancreatic head invasion. The literature on Brunnera's gland hyperplasia is reviewed.
Brunner Glands/*pathology/radiography ; *Choristoma ; Diagnosis, Differential ; Duodenal Neoplasms/*pathology/radiography/surgery ; Duodenum/pathology/radiography ; Endoscopy, Gastrointestinal ; Humans ; Hyperplasia ; Male ; Middle Aged ; Pancreatic Diseases/*pathology/radiography ; Pancreaticoduodenectomy ; Severity of Illness Index ; Tomography, X-Ray Computed

No abstract available.
Aged ; Female ; Gastrointestinal Neoplasms/*diagnosis/pathology/*secondary ; Humans ; Liver Neoplasms/*diagnosis/radiography/*secondary ; Melanoma/*pathology ; Skin Neoplasms/*pathology ; Tomography, X-Ray Computed

Clinical manifestations and imaging findings of mantle cell lymphoma involving gastrointestinal tract were evaluated. The subjects were 7 cases of mantle cell lymphoma involving the gastrointestinal tract. All cases were pathologically confirmed in our hospital during the period from April 1994 to July 2000. Five patients were male and 2 were female, and their age ranged from 49 to 63 years (average 57.4). The objectives were: 1) characteristics and distribution of multiple polyposis, 2) presence, location and enhancement pattern of bowel wall thickening or mass formation, 3) presence of splenomegaly, 4) presence and location of abdominal lymph node enlargement, 5) involved extra-abdominal organs, 6) combined cancer and location, and 7) other findings. All mantle cell lymphomas occurred in elderly persons, over 40 years, and most showed multiple polyposis (6/7), bowel wall thickening or mass formation (6/7), lymph node enlargements (6/7) and extra- abdominal involvement (5/7). All cases of polyposis involved the small bowel and colon, and the size of the polyps ranged from 0.1-4.0cm. Four of 6 patients showed combined sessile and polypoid polyps, while the other 2 showed only sessile polyps. Most of or some of the polyps in 3 patients showed small central ulcerations. Most of the patients (5/6) showed an uncountable number of polyps. Polyposis was predominant in the rectum, ascending colon, rather than other sections in the colon, and the ileum were almost always involved by polyposis. Bowel wall thickening or mass formation developed exclusively in the ascending colon, rectum or ileum. Extra- abdominal involvement developed either simultaneously or nonconcurrently with gastrointestinal involvement. Some of patients showed splenomegaly (3/7), appendiceal enlargement (2/7), and intussusception (1/7), and some had associated adenocarcinomas (3/7).
Barium Sulfate/diagnostic use ; Enema ; Female ; Gastrointestinal Neoplasms/*pathology/*radiography ; Human ; Lymphoma, Mantle-Cell/*pathology/*radiography ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVE: We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management. MATERIALS AND METHODS: In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores. RESULTS: The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction. CONCLUSION: Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/*adverse effects/therapeutic use ; Ascites/pathology/radiography ; Benzamides/*adverse effects/therapeutic use ; Echocardiography/methods ; Edema/pathology/radiography ; Female ; Gastrointestinal Stromal Tumors/drug therapy/pathology/*radiography ; Gastrointestinal Tract/pathology/*radiography ; Heart Failure/radiography ; Humans ; Male ; Middle Aged ; Molecular Targeted Therapy/*adverse effects ; Pericardial Effusion/pathology/radiography ; Peritoneal Neoplasms/diagnosis/radiography/secondary ; Piperazines/*adverse effects/therapeutic use ; Pleural Effusion/pathology/radiography ; Pyrimidines/*adverse effects/therapeutic use ; Radiology ; Retrospective Studies ; Tomography, X-Ray Computed

Intestinal intussusception caused by metastatic tumor is uncommon. Symptomatic small bowel metastases from lung cancer have been rarely reported. Here we report a case of intussusception with gastrointestinal bleeding induced by jejunal metastasis of non-small cell lung cancer with a review of the literature. A 52-year-old man was admitted to our hospital because of melena. He had underwent right pneumonectomy and received systemic chemotherapy with radiotherapy for squamous cell lung cancer. Esophagogastroduodenoscopy and colonoscopy failed to reveal bleeding focus. Abdominal CT scan revealed jejunal intussusception and histologic examination of resected jejunum showed metastatic mass from lung cancer. In patients with small bowel obstruction and history of malignancies, possibility of small bowel metastatic tumor should be considered.
Gastrointestinal Hemorrhage/*etiology ; Humans ; Intussusception/*etiology/radiography/surgery ; Jejunal Diseases/*etiology/radiography/surgery ; Jejunal Neoplasms/complications/pathology/*secondary ; Lung Neoplasms/*complications/pathology/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVE: To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. MATERIALS AND METHODS: We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. RESULTS: Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). CONCLUSION: Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.
Adult ; Aged ; Aged, 80 and over ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Stromal Tumors/pathology/*radiography ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Logistic Models ; Male ; Middle Aged ; Neurilemmoma/pathology/*radiography ; Retrospective Studies ; Statistics, Nonparametric ; Stomach Neoplasms/pathology/*radiography ; Tomography, X-Ray Computed/*methods

18F-FDG PET scan is an useful functional whole body imaging modality that images various types of malignancies with relative high sensitivity and specificity in a reasonably rapid time. It depicts a lesion based on abnormal glucose metabolism whereas CT detects malignant process mostly based on altered anatomy. In patients with gastric cancers, PET scan detects only less than 50% of early cancers and 62-98% of advanced cancers. For initial T staging, anatomical imaging with a high spatial resolution is essential. There are a few studies on the prognostic significance of FDG uptake with inconsistent results. In spite of low sensitivity for lymph node staging, the specificity of CT and PET scan are very high, and the specificity of PET scan tends to be higher than that of CT. Detection of distant metastases on PET scan is dependent on tumor histology, degree of FDG uptake in primary tumors, sites of distant metastases, etc. There are only a few data available for the evaluation of recurrence detection and treatment responses using FDG PET scan. FDG PET scan has been used in the preoperative staging of colorectal cancer with some promising results. It seems to be the most useful in restaging recurrent tumors and selecting those patients who would benefit from surgery. PET scan has a potential value in assessing treatment responses after various combination of treatments in patients with colorectal cancer.
Fluorodeoxyglucose F18/*diagnostic use ; Gastrointestinal Neoplasms/pathology/radiography/*radionuclide imaging ; Humans ; Neoplasm Staging ; *Positron-Emission Tomography ; Radiopharmaceuticals/*diagnostic use ; Tomography, X-Ray Computed