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

BACKGROUND/AIMS: The multidetector computed tomography (MDCT) scanning frequently leads to the incidental discovery of bowel wall thickening. The aim of this study was to determine the utility of gastroscopy and colonoscopy in the management of patients who had incidental discovery of bowel wall thickening on MDCT. METHODS: From May 2006 to March 2008, the abdominal MDCT reports of all patients in Chungbuk National University Hospital were reviewed. Cases with any bowel thickening was selected and then patients who received gastroscopy or colonoscopy after abdominal MDCT were re-selected. RESULTS: Gastroscopy revealed abnormal findings in 22 (95.7%) out of 23 patients, and 10 patients (43.5%) had stomach cancers. Colonoscopy revealed abnormal findings in 35 (85.4%) out of 41 patients, and 12 patients (29%) had malignant tumors. In the patients who had lymph node enlargement (p<0.001), dirty fat infiltration (p=0.025), and irregular wall thickening (p<0.001) on MDCT malignancy was observed more frequently. CONCLUSIONS: We recommend gastroscopy and colonoscopy to patients who had incidentally found bowel wall thickening on MDCT, especially those with lymph node enlargement, dirty fat infiltration, and irregular wall thickening.
Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/radiography ; Endoscopy, Gastrointestinal ; Female ; Humans ; Intestines/cytology/*radiography ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/radiography ; Tomography, X-Ray Computed/*methods

We report two cases of hepatic metastases from choriocarcinoma in women of childbearing age in whom imaging studies performed at presentation revealed the presence of liver masses, and who had clinically progressive anemia or intraabdominal hemorrhage. CT demonstrated heterogeneously enhanced liver masses. Characteristic angiographic findings included hypervascular hepatic masses with aneurysmal dilatations of the peripheral hepatic arteries at the arterial phase and persistent vascular lakes at the venous phase.
Adult ; Angiography ; Case Report ; Choriocarcinoma/*radiography/*secondary ; Female ; Gastrointestinal Hemorrhage/etiology ; Human ; Liver Neoplasms/radiography/*secondary ; Tomography, X-Ray Computed

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

Metastases from lung cancer to the gastrointestinal tract are not exceptional findings, but their clinical manifestations are rare. We report a new case of multiple metastases to the small bowel from primary lung cancer. A 67 year-old man presented with acute abdominal pain and vomiting. The laboratory investigations were all within normal limits except leukocytosis. Lung radiography was done and it showed infiltration at the right upper lung field without any mass. Abdominal CT-scan demonstrated a small bowel mass with ileoileal intussusception and the patient underwent emergency surgery. The postoperative lung studies and pathological analysis confirmed primary lung cancer with small bowel metastasis.
Abdominal Pain ; Aged ; Emergencies ; Gastrointestinal Tract ; Humans ; Intussusception ; Leukocytosis ; Lung Neoplasms* ; Lung* ; Neoplasm Metastasis ; Radiography ; Vomiting

With the evolution of immunochemical staining techniques and better imaging modalities with better image resolution and whole body coverage, gastrointestinal stromal tumor (GIST), the most common mesenchymal tumor of the gastrointestinal tract, is often encountered in clinical practice. Metastasis is common with malignant GIST and can be found in up to 50% of patients at presentation. Liver and peritoneum are the two most common sites of metastasis and accounted for 95% of cases. Lymphatics, bone and lung metastasis are rare. Malignant GIST with intracranial metastasis is even rarer, with only a few cases reported in the literature, and most of these had earlier metastasis elsewhere. Radiological features for GISTs are not specific but it does contribute to confirming early and accurate diagnosis of malignant GISTs by judging the tumor size, enhancement pattern and the invasion of adjacent structures. We report a case of a 26-year-old male with metastatic GIST to the liver and subsequently to the brain and skull vault. This is the first case reported in our locality and he is the youngest patient reported with this disease entity. The clinical progress, radiological features and the role of imaging will be discussed further in this paper. The radiological and clinical features of the primary tumor will specifically be addressed. The purpose of this paper is to enrich the current database of this rare disease entity and to alert both radiologists and clinicians about the imaging features of GIST with intracranial metastasis.
Adult ; Brain Neoplasms ; diagnostic imaging ; secondary ; Gastrointestinal Stromal Tumors ; complications ; diagnostic imaging ; Humans ; Male ; Radiography

OBJECTIVE: We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract. MATERIALS AND METHODS: Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fluoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fluoroscopic guidance) was performed in these patients. RESULTS: We achieved successfully percutaneous gastrostomy using the modified technique in all patients without any major or minor complications after the procedure. CONCLUSION: A modified radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract.
Adult ; Aged ; Conscious Sedation ; Contrast Media/diagnostic use ; Esophageal Neoplasms/radiography/*surgery ; Female ; Gastrostomy/*methods ; Humans ; Intestinal Obstruction/radiography/*surgery ; Iothalamate Meglumine/diagnostic use ; Laryngeal Neoplasms/radiography/*surgery ; Male ; Middle Aged ; Radiography, Interventional ; Retrospective Studies ; Upper Gastrointestinal Tract/radiography/*surgery

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

Gastrointestinal stromal tumor (GIST) represents the most common intramural mesenchymal tumor of the gastrointestinal tract, but the synchronous occurrence of GIST in the stomach and gynecological cancer is rare. We present a unique case of a 56-year-old female patient who was diagnosed with the synchronous development of GIST and an isolated parenchymal splenic metastasis of ovarian cancer. She underwent a wide local excision of gastric lesions with splenectomy. A morphological (histological and immunohistochemical) study established a spindle-cell type of gastrointestinal tumor that expressed CD117, and a parenchymal recurrence of ovarian papillary serous adenocarcinoma. The patient has remained alive and disease-free for 30 months since the last operation. A small GIST concomitant with an isolated parenchymal splenic metastasis of ovarian cancer is rarely encountered. The coexistence of GIST with other malignancies constitutes an intriguing oncologic model. Surgeons are advised to be alert against possible primary GIST accompanying other neoplasms.
Female ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; secondary ; Humans ; Middle Aged ; Ovarian Neoplasms ; complications ; Radiography ; Splenic Neoplasms ; secondary

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