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Tsurumaru D, Nishimuta Y, Kai S, Oki E, Minoda Y, Ishigami K. Clinical significance of dual-energy dual-layer CT parameters in differentiating small-sized gastrointestinal stromal tumors from leiomyomas. Jpn J Radiol 2023; 41:1389-1396. [PMID: 37464171 PMCID: PMC10687125 DOI: 10.1007/s11604-023-01473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Small gastrointestinal stromal tumors (GISTs) can generally have nonspecific CT findings similar to those with benign submucosal tumors of the stomach. The purpose of this study was to explore the potential dual-layer dual-energy CT (dlDECT) parameters to differentiate small-sized (≤ 4 cm) GISTs from leiomyomas of the stomach. MATERIALS AND METHODS This retrospective study included 26 SMTs ≤ 4 cm in diameter with pathological confirmation of either GIST (n = 17) or leiomyoma (n = 9) from May 2018 to January 2022. All patients received contrast-enhanced CT. The normalized iodine concentration (NIC) and spectral slope (λHU) were compared between GIST and leiomyoma. Receiver-operating characteristic (ROC) curves were plotted and the areas under the curve (AUCs) were calculated to estimate the diagnostic performance of these markers for differentiating GISTs from leiomyomas. RESULTS NIC was significantly higher in GIST than in leiomyoma in the portal (P = 0.0019) and delayed phases (P = 0.0011). λHU was significantly higher in GIST than in leiomyoma in the portal (P = 0.0006) and delayed phases (P = 0.0009). AUC of the ROC curves using NIC to differentiate between GIST and leiomyoma were 0.875 and 0.895 in the portal and delayed phase; using λHU, they were 0.918 and 0.902 in the portal and delayed phase. CONCLUSION dlDECT parameters including NIC and λHU show promise as indicators for differentiating small-sized GISTs from leiomyomas.
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Affiliation(s)
- Daisuke Tsurumaru
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan.
| | - Yusuke Nishimuta
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Satohiro Kai
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
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Mesenchymal tumors of the stomach: radiologic and pathologic correlation. Abdom Radiol (NY) 2022; 47:1988-2003. [PMID: 35347384 DOI: 10.1007/s00261-022-03498-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/01/2022]
Abstract
Mesenchymal tumors of the stomach are uncommon, with gastrointestinal stromal tumor (GIST) being the most common among them. Majority of the tumors may arise from cells of Cajal, smooth muscle cells, neural cells, totipotent stem cells, adipocytes or fibroblasts. Imaging plays an important role not only in staging but also in characterizing these tumors. Many of these tumors have characteristic imaging features. GISTs usually present as large cavitating and necrotic tumors with exophytic component. Presence of fat tissue within the tumor suggests a lipoma or a teratoma, early phase hyperenhancement indicates glomus tumor and hemangioma, and delayed contrast enhancement is seen in schwannoma. Their differentiation from epithelial tumors like carcinoma and neuroendocrine tumors is often possible based on the location (mesenchymal tumors are intramural), spread, morphological appearance and enhancement patterns. However, overlapping features exist between these tumors with imaging often being only suggestive. A biopsy is necessary for a definitive diagnosis in many cases.
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Xing JJ, Huang WP, Wang F, Chai YR, Gao JB. Computed tomography features and clinicopathological characteristics of gastric glomus tumor. BMC Gastroenterol 2022; 22:174. [PMID: 35397495 PMCID: PMC8994361 DOI: 10.1186/s12876-022-02241-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastric glomus tumor (GGT) is a rare neoplasm that is difficult to distinguish from other gastric submucosal tumors due to a lack of diagnostic experience. The goal of this study was to better understand GGT by looking at its clinicopathological features, computed tomography (CT) features, and differential diagnosis.
Methods
The clinical data and CT findings of 21 pathologically confirmed GGT patients were examined. The clinical characteristics and CT findings of benign GGT were compared to gastric stromal tumors (GST) (n = 30) and heterotopic pancreas (n = 30).
Results
The 21 cases included six males and fifteen females ranging in age from 42 to 64 years. The lesions were found in the gastric body in four cases and the antrum in seventeen. GGT was diagnosed as benign in 20 cases and malignant in one. In benign cases, the glomus cells were small, uniform, showed perivascular hemangiopericytoma‑like or solid nest‑like structures. Obvious mitotic figures were observed in the malignant case. SMA staining was positive in the tumor cells. A quasi-round or round solid mass protruded into the gastric cavity in 20 benign cases, with a clear and smooth edge. The long to short diameter ratio was 1.01 ± 0.15. All of the benign cases had obvious enhancement, with homogeneous enhancement in ten cases and heterogeneous enhancement in ten cases, as well as central filling enhancement in 12 cases. The ratio of CT value of lesion to abdominal aorta in arterial phase and venous phase were (0.41 ± 0.11) and (0.81 ± 0.20), which were significantly higher than GST and heterotopic pancreas. The irregular mass broke through the gastric wall and invaded liver with poorly defined boundary and internal necrosis, heterogeneous persistent moderate enhancement with thickening blood supply arteries was seen in one malignant case with a long diameter of 150 mm and a thick diameter of 30 mm.
Conclusions
CT enhancement usually shows persistent obvious enhancement, especially in arterial phase, which provides important value for the diagnosis. CT findings can help in the differential diagnosis of GGT and other submucosal tumors.
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Yang CW, Che F, Liu XJ, Yin Y, Zhang B, Song B. Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. Insights Imaging 2021; 12:144. [PMID: 34674040 PMCID: PMC8531187 DOI: 10.1186/s13244-021-01089-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
Heterotopic pancreas (HP) is an uncommon congenital abnormality in the developmental process of the pancreas, with gastrointestinal heterotopic pancreas (GHP) being the most common HP. The clinical manifestations of GHP may have variable patterns of presentation, dictated by both the anatomic location and the functional ability of the lesion. The most common imaging modality in detecting GHP is computed tomography (CT), while gastrointestinal barium fluoroscopy, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are also applied. The density and enhancement patterns of GHP are consistent with histological classifications. GHP with a predominantly acinar tissue component manifests homogeneous and marked enhancement on CT images, whereas a predominantly ductal GHP presents heterogeneous and mild enhancement. On MRI, the appearance and signal intensity of GHP were paralleled to the normal pancreas on all sequences and were characterized by T1-weighted high signal and early marked enhancement. This article provides a comprehensive review of the histopathology, clinical manifestations, imaging features of various modalities, and differential diagnosis of GHP. It is hoped that this review will improve clinicians' knowledge of GHP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate.
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Affiliation(s)
- Cai-Wei Yang
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Feng Che
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Duanmu J, Liang Y, Huang Z, Tan Y, Li T, Lei X. Cavernous haemangioma of the duodenum with acute massive bleeding in the ascending portion: a case report. J Int Med Res 2021; 49:3000605211010091. [PMID: 34590919 PMCID: PMC8489767 DOI: 10.1177/03000605211010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Duodenal cavernous haemangiomas are rare, benign disorders, and massive gastrointestinal (GI) bleeding is a rare clinical condition. The present case report describes a 50-year-old male patient who presented with severe, ongoing haematochezia. A peripheral blood smear at the time of admission showed significant anaemia, and haemoglobin level was 52 g/l (normal range, 120–175 g/l). Albumin level was also low at 28 g/l (normal range, 40–55 g/l). Standard computed tomography (CT) showed mural thickening and relative lumen stenosis in the ascending (fourth) portion of the duodenum. Contrast-enhanced CT using hypotonic solution revealed the lesions to be hypervascular haemangiomas. Laparotomy and segmental duodenum resection were performed, and the first jejunal limb was anastomosed using a side-to-end technique. Histopathological examination confirmed the diagnosis of cavernous haemangioma. The patient showed marked improvement during follow-up. The present case findings emphasize that duodenal haemangioma is possible without a history of chronic anaemia, and should remain a consideration in differential diagnosis for patients presenting with massive GI bleeding. CT is useful for preoperative diagnosis of massive bleeding, and surgery with segmental resection is usually curative.
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Affiliation(s)
- Jinzhong Duanmu
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yahang Liang
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhixiang Huang
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yongming Tan
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Taiyuan Li
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Gastrointestinal Surgery Institute, Nanchang University, Nanchang, Jiangxi, China
| | - Xiong Lei
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Gastrointestinal Surgery Institute, Nanchang University, Nanchang, Jiangxi, China
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Zeydanli T, Kilic HK. Performance of quantitative CT texture analysis in differentiation of gastric tumors. Jpn J Radiol 2021; 40:56-65. [PMID: 34304383 DOI: 10.1007/s11604-021-01181-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/18/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To examine the computed tomography (CT) images of patients with a diagnosis of gastric tumor by texture analysis and to investigate its place in differential diagnosis. MATERIALS AND METHODS Contrast enhanced venous phase CT images of 163 patients with pathological diagnosis of gastric adenocarcinoma (n = 125), gastric lymphoma (n = 12) and gastrointestinal stromal tumors (n = 26) were retrospectively analyzed. Pixel size adjustment, gray-level discretization and gray-level normalization procedures were applied as pre-processing steps. Region of interest (ROI) was determined from the axial slice that represented the largest lesion area and a total of 40 texture features were calculated for each patient. Texture features were compared between the tumor subtypes and between adenocarcinoma grades. Statistically significant texture features were combined into a single parameter by logistic regression analysis. The sensitivity and specificity of these features and the combined parameter were measured to differentiate tumor subtypes by receiver-operating characteristic curve (ROC) analysis. RESULTS Classifications between adenocarcinoma versus lymphoma, adenocarcinoma vs. gastrointestinal stromal tumor (GIST) and well-differentiated adenocarcinoma versus poorly differentiated adenocarcinoma using texture features yielded successful results with high sensitivity (98, 91, 96%, respectively) and specificity (75, 77, 80%, respectively). CONCLUSIONS CT texture analysis is a non-invasive promising method for classifying gastric tumors and predicting gastric adenocarcinoma differentiation.
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Affiliation(s)
- Tolga Zeydanli
- Radiology Department, Ardahan Devlet Hastanesi, 75000, Ardahan, Turkey.
| | - Huseyin Koray Kilic
- Radiology Department, Gazi University School of Medicine, 06500, Ankara, Turkey
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Andhalgaonkar T, Sinha R. Mesenchymal Tumors and Lymphoproliferative Diseases of the Stomach and Duodenum. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1722794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractNeoplasms of the stomach are classified into two large categories on the basis of the cell of origin: epithelial and nonepithelia. The vast majority of both benign and malignant tumors of the stomach are of epithelial origin, with mesenchymal and neuroendocrine tumors being much less common. The epithelial tumors arise from the mucosa while the nonepithelial tumors arise from the submucosa, muscularis propria, or serosa. The nonepithelial or intramural tumors of stomach include gastrointestinal stromal tumors, leiomyomas, schwannoma, granular cell tumors, glomus tumor, leiomyosarcoma, Kaposi sarcoma, lymphoma, and others. In this review, radiological appearance of mesenchymal tumors and lymphoproliferative tumors are described.
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Affiliation(s)
- Tanmay Andhalgaonkar
- Department of Clinical Radiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
| | - Rakesh Sinha
- Department of Clinical Radiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
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Abstract
Background Glomus tumors (GTs) are mesenchymal neoplastic lesions arising from the glomus bodies and generally occur in the fingers and toes. Gastrointestinal GTs are rare, and most of them originate from the stomach; however, GT arising from the duodenum is exceedingly rare. Case presentation A 68-year-old man was admitted due to abdominal pain. Endoscopy showed a round, smooth, elevated mass in the second portion of the duodenum with central ulceration. Abdominal contrast computed tomography showed a hypervascular tumor measuring 26 mm in diameter in the second portion of the duodenum, and pancreatic invasion was suspected. Endoscopic ultrasonography of the lesion confirmed a hypoechoic mass arising from the fourth layer of the duodenal wall. A biopsy was performed for central ulceration, and immunochemical studies showed positive results for smooth muscle actin (SMA) and negative results for S100, C-Kit, and CD34. Leiomyoma or gastrointestinal stromal tumor was suspected and pancreatoduodenectomy was performed. The specimen exhibited a vascular-rich tumor, 24 × 24 × 19 mm in size, with deep ulceration in the duodenum. Histological examination showed uniform small round cells with central nuclei and a pale cytoplasm (glomus cell) with perivascular proliferation. Immunochemical studies showed that the tumor was positive for SMA and collagen type IV, and negative for C-Kit, CD34, desmin, and S100. We diagnosed the tumor as a GT of the duodenum. Conclusion GTs of the duodenum are exceedingly rare, but should be considered in the differential diagnoses of duodenal submucosal lesions.
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Peng G, Huang B, Yang X, Pang M, Li N. Preoperative CT feature of incomplete overlying enhancing mucosa as a high-risk predictor in gastrointestinal stromal tumors of the stomach. Eur Radiol 2020; 31:3276-3285. [PMID: 33125563 DOI: 10.1007/s00330-020-07377-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether the CT finding of overlying enhancing gastric mucosa (OEGM) can be used to predict risk stratifications by observing CT features of gastrointestinal stromal tumors (GISTs) of the stomach. METHODS Clinical characteristics and CT features within pathologically demonstrated GISTs were retrospectively reviewed. Risk stratifications were classified into non-high group and high-risk group according to the modified National Institutes of Health criteria. Univariate analysis and multivariate logistic regression analysis were performed in order to determine significant predictors for high-risk stratification. Receiver operating characteristic (ROC) curve analysis, subgroup analysis, and pathologic-radiologic correlation analysis were all executed. RESULTS A total of 147 patients were finally enrolled as test subjects. Within the univariate analysis, high-risk tumors tended to have a larger diameter, irregular shape, exophytic growth pattern, present necrosis, incomplete OEGM, tumor vessels, heterogeneous enhancement, and present rupture. According to ROC curve analysis, incomplete OEGM showed the largest area under curve values for diagnosing lesions (0.835; 95% CI, 0.766-0.904; p < 0.001). Multivariate analysis showed that the incomplete OEGM was the strongest independent predictor for high-risk stratification of gastric GISTs (OR = 21.944; 95% CI, 4.344-110.863; p < 0.001). Within the subgroup analysis, incomplete OEGM was more frequently associated with tumors size > 10 cm, irregular shape, exophytic growth pattern, high mitotic count, and disrupted mucosa on pathology. CONCLUSIONS The CT feature of incomplete OEGM is an independent predictive factor for high-risk stratification of gastric GISTs and strongly correlated with pathological mucosal changes. KEY POINTS • Preoperative CT features can be helpful in assessment of risk stratifications of gastric GISTs. • OEGM is an independent predictor for high-risk stratification of gastric GISTs. • Incomplete OEGM likely indicates high-risk stratification of gastric GISTs.
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Affiliation(s)
- Gang Peng
- Department of Radiology, Shanghai Pudong New Area Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong New Area, Shanghai, 201318, China
| | - Bingcang Huang
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, No. 219 Miaopu Road, Pudong New Area, Shanghai, 200135, China
| | - Xiaodan Yang
- Department of Radiology, Shanghai Pudong New Area Gongli Hospital, No. 219 Miaopu Road, Pudong New Area, Shanghai, 200135, China
| | - Maohua Pang
- Department of Radiology, Shanghai Pudong New Area Zhoupu Hospital, No. 1500 Zhouyuan Road, Pudong New Area, Shanghai, 201318, China
| | - Na Li
- Department of Ultrasound and Radiology, Daqing Oilfield General Hospital, No. 9 Zhongkang Road, Saertu District, Daqing, 163000, Heilongjiang, China.
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10
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Wang J, Liu C, Ao W, An Y, Zhang W, Niu Z, Jia Y. Differentiation of gastric glomus tumor from small gastric stromal tumor by computed tomography. J Int Med Res 2020; 48:300060520936194. [PMID: 32779507 PMCID: PMC7425284 DOI: 10.1177/0300060520936194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study was performed to investigate the value of computed tomography (CT) in the differentiation of gastric glomus tumors (GGTs) and small gastric stromal tumors (GSTs). METHODS Fifty-nine patients with pathologically confirmed GGTs (n = 11) and GSTs (n = 48) from 2006 to 2019 were retrospectively evaluated. All patients' preoperative CT imaging features were analyzed. RESULTS The following features were significantly different between GGTs and small GSTs: location in the antrum, endophytic growth, heterogeneous enhancement in the arterial phase, CT value in the arterial phase of ≥60.7 Hounsfield units (HU), CT value in the portal phase of ≥87.6 HU, degree of enhancement in the arterial phase of ≥29.9 HU, and degree of enhancement in the portal phase of ≥49.0 HU. A model including four randomly selected features among these seven criteria was built to differentiate GGTs from small GSTs with a sensitivity and specificity of 90.9% (10/11) and 100% (48/48), respectively. CONCLUSION We identified seven features that are useful for differentiating GGTs from small GSTs. A combination of four of these seven criteria may increase the diagnostic accuracy.
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Affiliation(s)
- Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Chang Liu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Weiqun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Yongyu An
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Wenming Zhang
- Department of Radiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang Province, China
| | - Zhongfeng Niu
- Department of Radiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang Province, China
| | - Yuzhu Jia
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
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11
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Yoon J, Kim K, Lee S. Imaging findings of glomus tumor at duodenum: a case description. Quant Imaging Med Surg 2020; 10:1133-1137. [PMID: 32489933 DOI: 10.21037/qims.2020.03.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jongjin Yoon
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeongmin Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sunyoung Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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12
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Yin X, Yin Y, Liu X, Yang C, Chen X, Shen C, Chen Z, Zhang B, Cao D. Identification of gastrointestinal stromal tumors from leiomyomas in the esophagogastric junction: A single-center review of 136 cases. Medicine (Baltimore) 2020; 99:e19884. [PMID: 32332661 PMCID: PMC7220686 DOI: 10.1097/md.0000000000019884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To identify significant clinical and CT features for the differentiation of gastrointestinal stromal tumors (GISTs) from leiomyomas in the esophagogastric junction (EGJ).One hundred thirty six patients with pathologically proven GISTs (n = 87) and leiomyomas (n = 49) in the EGJ were enrolled. And preoperative CT images were available in 73 GISTs cases and 34 leiomyoma cases. Two radiologists reviewed the CT images by consensus with regard to tumor size, shape, growth pattern, surface, enhancement pattern, enhancement degree, attention at each phasic image and the presence of surface ulcer, calcification, and intralesional low attention.Eight significant clinical and CT features were identified for differentiating GISTs from leiomyomas: older age (>46.5 years), tumor long diameter >4.5 cm, heterogeneous enhancement, high degree enhancement, mean CT attenuation >69.2 HU, presences of intralesional low attenuation and surface ulcer, absences of calcification (P < .05). On the receiver operating characteristic curve analysis, an optimal cutoff score of 3.5 was achieved for differentiating GISTs from leiomyomas with an AUC of 0.844 (sensitivity: 76.7%, specificity: 76.5%).older age (>46.5 years), tumor long diameter >4.5 cm, heterogeneous enhancement, high degree enhancement, mean CT attenuation >69.2 HU, presences of intralesional low attenuation and surface ulcer, absence of calcification are significant features highly suggestive of GISTs in differentiation from leiomyomas in the EGJ.
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Affiliation(s)
| | - Yuan Yin
- Department of Gastrointestinal Surgery
| | | | | | - Xin Chen
- Department of Gastrointestinal Surgery
| | | | | | - Bo Zhang
- Department of Gastrointestinal Surgery
| | - Dan Cao
- Department of Medical Oncology, Cancer Center, and the State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
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13
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Wang J, Zhou X, Xu F, Ao W, Hu H. Value of CT Imaging in the Differentiation of Gastric Leiomyoma From Gastric Stromal Tumor. Can Assoc Radiol J 2020; 72:444-451. [PMID: 32106696 DOI: 10.1177/0846537119885671] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: To discuss significant computed tomography (CT) findings that differentiate gastric leiomyomas (GLs) from small gastric stromal tumors (GSTs). Methods: One hundred sixty cases with pathologically proven GLs (n = 50) and GSTs (n = 110) with comprehensive CT images were enrolled in this retrospective study. Computed tomography findings (ie, size, location, contour, growth pattern, enhancement degree, necrosis, ulceration, calcification, and lymph nodes) were analyzed through the χ2 or Fisher exact test, independent T test, and multivariate (logistic regression) analysis. Sensitivity and specificity were also calculated. Results: Features of cardia location, endophytic growth, homogeneous gradual enhancement, absent of necrosis, long diameter less than 24 mm, short diameter less than 20 mm, unenhanced CT value larger than 35.2 Hounsfield units (HU), portal venous phase CT value larger than 67.4 HU, and enhancement degree of arterial and venous phase less than 16.2 HU and 32.4 HU were found to be statistically significant between GLs and small GSTs ( P < .05). On multivariate analysis, cardia location, endophytic growth, and homogeneous gradual enhancement were independent predictive factors for GLs and small GSTs. Conclusion: These 10 CT criteria are very helpful to differentiate GLs from small GSTs. Especially cardia location, endophytic growth, and homogeneous gradual enhancement are of high value in differential diagnosis.
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Affiliation(s)
- Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiaoxuan Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, 12377Zhejiang University, Hangzhou, Zhejiang, China
| | - Fangyi Xu
- Department of Radiology, Sir Run Run Shaw Hospital, 12377Zhejiang University, Hangzhou, Zhejiang, China
| | - Weiqun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, 12377Zhejiang University, Hangzhou, Zhejiang, China
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14
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The Role of Endoscopic Ultrasound and Endoscopic Resection for Gastric Glomus: A Case Series and Literature Review. J Transl Int Med 2019; 7:149-154. [PMID: 32010601 PMCID: PMC6985914 DOI: 10.2478/jtim-2019-0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Objectives Preoperative diagnosis of gastric glomus tumor is very difficult, and there are few reports regarding the endoscopic treatment of glomus tumor of the stomach. Our aim is to provide a retrospective assessment of the imaging features of endoscopic ultrasound (EUS) and treatment of choice of gastric glomus tumor. Methods A database of all patients with gastric glomus tumor who was treated at Shengjing Hospital of China Medical University between March 2011 and March 2017 was retrospectively analyzed. The EUS characteristics and patients’ clinical data as well as their treatment were reviewed. At the same time, we compared EUS characteristics of gastric glomus tumor with that of gastrointestinal stromal tumor (GISTs), leiomyomas, schwannomas, and ectopic pancreas. Results Eleven patients (3 male and 8 female patients) were included in the present study. The patients’ age ranged from 37 to 62 years (mean age, 50.1 years). Ten patients received EUS examination. Eight lesions were presented with mild-hyperechoic round or oval mass; one lesion was mild-hyperechoic oval mass with hypoechoic spots; one lesion was hypoechoic oval mass. One patient received endoscopic full-thickness resection; 3 patients were treated by endoscopic submucosal dissection; and laparoscopic resection was performed for 7 patients. Conclusions Gastric glomus has typical EUS features to differentiate from other submucosal tumors. Compared with surgery, endoscopic resection is also a safe and effective treatment of choice for gastric glomus tumor.
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Liu M, Liu L, Jin E. Gastric sub-epithelial tumors: identification of gastrointestinal stromal tumors using CT with a practical scoring method. Gastric Cancer 2019; 22:769-777. [PMID: 30535637 DOI: 10.1007/s10120-018-00908-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine CT features that can identify gastrointestinal stromal tumors (GISTs) among gastric sub-epithelial tumors (SETs) and to explore a practical scoring method. METHODS Sixty-four patients with gastric SETs (51 GISTs and 13 non-GISTs) from hospital I were included for primary analyses, and 92 (67 GISTs and 25 non-GISTs) from hospital II constituted a validation cohort. Pre-operative CT images were reviewed for imaging features: lesion location, growth pattern, lesion margin, enhancement pattern, dynamic pattern, attenuation at each phasic images and presence of necrosis, superficial ulcer, calcification, and peri-lesion enlarged lymph node (LN). Clinical and CT features were compared between the two groups (GISTs versus non-GISTs) and a GIST-risk scoring method was developed; then, its performance for identifying GISTs was tested in the validation cohort. RESULTS Seven clinical and CT features were significantly suggestive of GISTs rather than non-GISTs: older age (> 49 years), non-cardial location, irregular margin, lower attenuation on unenhanced images (≤ 43 HU), heterogeneous enhancement, necrosis, and absence of enlarged LN (p < 0.05). At validation step, the established scoring method with cut-off score dichotomized into ≥ 4 versus < 4 for identifying GISTs revealed an AUC of 0.97 with an accuracy of 92%, a sensitivity of 100% and a negative predictive value (NPV) of 100%. CONCLUSIONS Gastric GISTs have special CT and clinical features that differ from non-GISTs. With a simple and practical scoring method based on the significant features, GISTs can be accurately differentiated from non-GISTs.
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Affiliation(s)
- Ming Liu
- Department of Radiotherapy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Liheng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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CT Versus Endoscopic Ultrasound for Differentiating Small (2-5 cm) Gastrointestinal Stromal Tumors From Leiomyomas. AJR Am J Roentgenol 2019; 213:586-591. [PMID: 31063418 DOI: 10.2214/ajr.18.20877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE. Abdominal CT or endoscopic ultrasound is recommended for the evaluation of gastric subepithelial tumors. However, few studies have compared the diagnostic performance of these two methods. We compared the diagnostic performance of CT versus endoscopic ultrasound for gastric subepithelial tumors smaller than 5 cm. We also identified significant CT findings associated with the diagnosis of gastrointestinal stromal tumors. MATERIALS AND METHODS. Seventy-one patients with pathologically proven gastric subepithelial tumors were enrolled. We examined the diagnostic performance of CT compared with endoscopic ultrasound. We analyzed CT findings, including the location, long diameter (LD), short diameter (SD), LD-SD ratio, contour, margin, growth pattern, degree and pattern of enhancement, attenuation value, intralesional necrosis, calcification, hemorrhage, surface dimpling, and perilesional lymph node. RESULTS. Endoscopic ultrasound had a sensitivity of 77.6%, specificity of 61.5%, PPV of 90.0%, NPV of 38.1%, and accuracy of 74.6%. CT had a sensitivity of 84.5%, specificity of 53.8%, PPV of 89.1%, NPV of 43.8%, and accuracy of 78.9%. Multivariate analysis revealed that the presence of intralesional necrosis (odds ratio [OR], 10.88; p = 0.037) and an LD-SD ratio less than 1.5 (OR, 32.37; p = 0.002) were independent CT findings for the diagnosis of gastrointestinal stromal tumors. CONCLUSION. CT is as effective as endoscopic ultrasound for the diagnosis of gastric subepithelial tumors smaller than 5 cm. Tumors with intralesional necrosis and an LD-SD ratio less than 1.5 may require further pathologic diagnosis.
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Abstract
Objective Primary malignant glomus tumors of the thyroid gland are a rare occurrence. Methods A 68-year-old man found a mass on the right side of his neck in October 2017. An X-ray examination on 9 January 2018 showed multiple round reinforced masses in both sides of the lung. Computed tomography imaging of the neck showed a low-density mass on the right side of the thyroid gland. Results The immunohistochemistry results were positive for smooth muscle actin, calponin, collagen IV, and Ki-67 60%. The patient received chemotherapy starting on 17 January 2018, 8 February 2018, and 11 March 2018. The chemotherapy drugs included ifosfamide, epirubicin, and cisplatin. However, the patient subsequently developed multiple organ failure and died in April 2018, approximately 6 months after the initial discovery of the mass in his neck. Conclusions Primary malignant glomus tumors of the thyroid gland are rare, and examination of their pathology and immunohistochemistry is vital for making an accurate final diagnosis. This case also indicates that primary malignant glomus tumors of the thyroid gland may have a poor prognosis, despite chemotherapy.
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Affiliation(s)
- Yinhua Liu
- 1 Department of Pathology, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
| | - Rongrong Wu
- 2 Department of Education, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
| | - Tao Yu
- 3 Department of Critical Care Medicine, Research Center for Functional Maintenance and Reconstruction of Viscera, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
| | - Yingya Cao
- 3 Department of Critical Care Medicine, Research Center for Functional Maintenance and Reconstruction of Viscera, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
| | - Linming Lu
- 1 Department of Pathology, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
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Wang J, Zhang W, Zhou X, Xu J, Hu HJ. Simple Analysis of the Computed Tomography Features of Gastric Schwannoma. Can Assoc Radiol J 2019; 70:246-253. [PMID: 30853303 DOI: 10.1016/j.carj.2018.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/10/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The objective of this study was to assess the computed tomography (CT) findings of gastric schwannoma (GS) and identify the difference between large (> 5 cm) and small (≤ 5 cm) GS. MATERIALS AND METHODS CT findings of 38 pathologically proven cases of GSs were retrospectively reviewed. The CT evaluation of GS included categorical variables (location, contour, growth pattern, enhancement pattern, necrosis, ulceration, calcification, and lymph nodes) and continuous variables (size, CT value of 3 phases, and enhancement degree). The lesion was divided into 2 groups (large [> 5 cm] and small [≤ 5 cm] GS) according to the tumor size. The Fisher exact test was used for categorical variables and the Student t or Mann-Whitney U test for continuous variables. RESULTS Of the 38 patients, there were 32 women and 6 men. The median age was 54.5 years (range 39-79). Most of patients (65.8%, [25 of 38]) had nonspecific gastrointestinal symptoms such as abdominal or gastric pain, fullness and discomfort, bleeding, and melena. The tumors were mainly located in the stomach body (71.1% [27 of 38]), and the mean diameter was 3.7 cm (range 1.5 cm-10.3 cm), of which included large (> 5 cm) (n = 8) and small (≤ 5 cm) (n = 30). All of the GSs were benign, 9 of whom had palpable perigastric lymph nodes, which confirmed by pathology for the reactive inflammatory hyperplasia. Growth pattern, pattern of enhancement, necrosis, calcification, surface ulceration, and lymph node in the CT images were found to be significant variables for differentiating large (> 5 cm) and small (≤ 5 cm) GS (P < .05). CONCLUSION GSs were predominantly located at the gastric body and occurred most frequently in women between the ages of 40-70 years, and showed gradual enhancement after contrast enhancement. Palpable perigastric lymph nodes could not be considered as malignant factor of GS. There 7 computed CT criteria are significant difference between large (> 5 cm) and small (≤ 5 cm) GS.
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Affiliation(s)
- Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Wenming Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiaoxuan Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Junliang Xu
- Department of Radiology, Jianggan District People's Hospital, Hangzhou, Zhejiang Province, China
| | - Hong-Jie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang Province, China.
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Ramai D, Tan QT, Nigar S, Ofori E, Etienne D, Reddy M. Ulcerated gastric leiomyoma causing massive upper gastrointestinal bleeding: A case report. Mol Clin Oncol 2018; 8:671-674. [PMID: 29725533 DOI: 10.3892/mco.2018.1597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/07/2018] [Indexed: 11/05/2022] Open
Abstract
Leiomyomas are rare, benign submucosal tumors originating from smooth muscle cells. The clinical presentation is usually asymptomatic, with excellent prognosis. We herein report the case of a 68-year-old female with a solitary leiomyoma found during esophagogastroduodenoscopy for hematemesis. Histopathological examination revealed smooth muscle proliferation supported by positive staining for smooth muscle myosin heavy chain and negative staining for CD117 and S-100, consistent with the marker expression pattern of leiomyoma. We report on the clinical presentation of this case, and discuss the origin, epidemiology, treatment and management of leiomyomas.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA.,Department of Anatomical Sciences, St. George's University School of Medicine, True Blue, Grenada, West Indies
| | - Qiuxue T Tan
- Department of Anatomical Sciences, St. George's University School of Medicine, True Blue, Grenada, West Indies
| | - Sofia Nigar
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA
| | - Emmanuel Ofori
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA
| | - Denzil Etienne
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA
| | - Madhavi Reddy
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, NY 11201, USA
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Aoba T, Kato T, Hiramatsu K, Shibata Y, Yoshihara M, Yamaguchi N, Kamiya T. A case of gastric glomus tumor resection using laparoscopy endoscopy cooperative surgery (LECS). Int J Surg Case Rep 2017; 42:204-207. [PMID: 29275234 PMCID: PMC5985262 DOI: 10.1016/j.ijscr.2017.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/10/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gastric glomus tumors are rare submucosal mesenchymal tumors. Because gastric glomus tumors are submucosal tumors and resemble gastrointestinal stromal tumors (GISTs), preoperative diagnosis is difficult. We present a case of gastric glomus tumor that was removed by laparoscopy endoscopy cooperative surgery (LECS). CASE PRESENTATION A 67-year-old female was taken to the emergency room at our hospital due to epigastric pain. An upper gastrointestinal endoscopy revealed a submucosal tumor (SMT) located in the lesser curvature of the upper body of the stomach. Endoscopic ultrasonography revealed an intraluminal hypoechoic tumor located in the third or fourth layer of the stomach wall. Contrast-enhanced computed tomography (CECT) of the abdomen showed a 20-mm, well-enhanced, intraluminal-type tumor located in the lesser curvature of the upper body of the stomach. Laparoscopy endoscopy cooperative surgery (LECS) was performed. Immunohistochemistry revealed the expression of smooth muscle actin and vimentin, but not of keratin, S-100 protein, C-kit, or CD34. The tumor was finally diagnosed as a gastric glomus tumor. CONCLUSION Glomus tumors are rare submucosal tumors of the stomach, and they should be considered in the differential diagnosis of gastric submucosal tumors. LECS could be a less invasive and effective method for treatment of gastric glomus tumor.
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Affiliation(s)
- Taro Aoba
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan.
| | - Takehito Kato
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Kazuhiro Hiramatsu
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Yoshihisa Shibata
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Motoi Yoshihara
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Naoya Yamaguchi
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Tadahiro Kamiya
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
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Lin YM, Chiu NC, Li AFY, Liu CA, Chou YH, Chiou YY. Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review. World J Gastroenterol 2017; 23:2493-2504. [PMID: 28465633 PMCID: PMC5394512 DOI: 10.3748/wjg.v23.i14.2493] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/25/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Although gastric tumors have overlapping radiologic appearances, some unusual tumors may present specific imaging features. Using multidetector computed tomography (MDCT), with water as a negative oral contrast agent and intravenous contrast medium, can provide critical information for the diagnosis of gastric diseases. In addition, MDCT can evaluate the involvement of the gastric wall and extragastric extent of the disease, as compared with gastroenteroscopy and double-contrast upper gastrointestinal study. Regarding lesion location and size, enhancing and growth patterns, presence of calcification or fat, and involvement of the gastric wall and adjacent structures, CT may provide useful information. In this review article, we review the relevant literature and discuss the CT features and the histopathologic findings of different types of gastric lesions. The lesions are divided into benign (glomus tumors, schwannomas, leiomyomas, and lipomas), malignant (gastrointestinal stromal tumors, mucinous carcinomas, lymphomas, and carcinoid tumors), and tumor-like lesions (ectopic pancreas and bezoar). Familiarity with imaging appearances and pathologic findings can help physicians make an accurate diagnosis.
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Richman DM, Tirumani SH, Hornick JL, Fuchs CS, Howard S, Krajewski K, Ramaiya N, Rosenthal M. Beyond gastric adenocarcinoma: Multimodality assessment of common and uncommon gastric neoplasms. Abdom Radiol (NY) 2017; 42:124-140. [PMID: 27645897 DOI: 10.1007/s00261-016-0901-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite advances in molecular biology, imaging, and treatment, gastric neoplasms remain a significant cause of morbidity and mortality; gastric adenocarcinoma is the fifth most common malignancy and third most common cause of death worldwide (Brenner et al., Methods Mol Biol 472:467-477, 2009; Howson et al. Epidemiol Rev 8:1-27, 1986; Roder, Gastric Cancer 5(Suppl 1):5-11, 2002; Ferlay et al., GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. International Agency for Research on Cancer, 2013). Because of both the frequency at which malignant gastric tumors occur as well as the worldwide impact, gastric neoplasms remain important lesions to identify and characterize on all imaging modalities. Despite the varied histologies and behaviors of these neoplasms, many have similar imaging features. Nonetheless, the treatment, management, and prognosis of gastric neoplasms vary by pathology, so it is essential for the radiologist to make every effort to differentiate between these lesions and raise the less common entities as differential diagnostic considerations when appropriate.
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Han GJ, Kim JH, Lee SS, Park SH, Lee JS, Ha HK. Inflammatory fibroid polyps of the gastrointestinal tract: a 14-year CT study at a single institution. ACTA ACUST UNITED AC 2016; 40:2159-66. [PMID: 25896613 DOI: 10.1007/s00261-015-0431-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the computed tomography (CT) features of pathology-proven inflammatory fibroid polyps (IFPs) in the gastrointestinal tract. METHODS This retrospective series study included 27 patients with pathology-proven IFPs in the stomach (n = 16), small (n = 9), and large (n = 2) intestine, who underwent contrast-enhanced CT. Two radiologists reviewed the CT images of the patients to determine in consensus the long diameter, shape, margin, contour, and growth pattern of the lesions, the presence of an ulcer and overlying mucosal hyperenhancement, the lesion enhancement patterns including the homogeneity and the degree of contrast enhancement, and the presence of intussusception and obstruction. The CT results and clinical data of the gastric and intestinal lesions were compared. RESULTS The IFPs typically manifested as well-defined (89%), round or ovoid (81%), slightly lobulated-contoured (70%) masses with a purely endoluminal growth pattern (96%) and an overlying mucosal hyperenhancement (67%). Lesion homogeneity and the degree of contrast enhancement varied. The intestinal IFPs were significantly larger (3.5 vs. 2 cm), more symptomatic (82% vs. 19%), and more frequently associated with intussusception (73% vs. 0%) and obstruction (46% vs. 6%) than the gastric lesions (p ≤ 0.027). CONCLUSIONS The characteristic CT features of IFPs were well-defined, round or ovoid, lobulated-contoured, and endoluminal masses with overlying mucosal hyperenhancement and various enhancement patterns. IFP should be included in the differential diagnosis of patients with a soft-tissue mass in the gastrointestinal tract, especially if a large endoluminal mass in the small intestine is accompanied by intussusception.
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Affiliation(s)
- Ga Jin Han
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea.
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jong Seok Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Hyun Kwon Ha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
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Yang HK, Kim YH, Lee YJ, Park JH, Kim JY, Lee KH, Lee HS. Leiomyomas in the gastric cardia: CT findings and differentiation from gastrointestinal stromal tumors. Eur J Radiol 2015; 84:1694-700. [PMID: 26051977 DOI: 10.1016/j.ejrad.2015.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe CT findings of leiomyomas and gastrointestinal stromal tumors (GISTs) in the gastric cardia and to identify their differentiating features. MATERIALS AND METHODS CT images of pathologically proven leiomyomas (n=26) and GISTs (n=19) in the gastric cardia were retrospectively reviewed for esophagogastric junction (EGJ) involvement, contour, surface, growth pattern, enhancement pattern and degree of the tumor, and the presences of intralesional low attenuation, calcification and surface dimples or ulcers. The long (LD) and short diameters (SD), LD/SD ratio, and attenuation value of each lesion were measured. RESULTS EGJ involvement, homogeneous enhancement, intermediate or low enhancement, absences of intralesional low attenuation and surface dimples or ulcers, LD/SD ratio >1.2, and attenuation value ≤71.2HU were significant findings for differentiating leiomyomas from GISTs (P<0.05 for each finding). An LD/SD ratio of >1.2 and attenuation value of ≤71.2HU yielded sensitivities of 84.6% and 61.5%, and specificities of 52.6% and 84.2%, respectively, on the receiver operating characteristic curve analysis. When at least five of these seven criteria were used in combination, the sensitivity and specificity for diagnosing leiomyomas were 100% (26 of 26) and 89.5% (17 of 19), respectively. When any six of these criteria were used, a specificity of 100% was achieved. CONCLUSIONS CT features including EGJ involvement, enhancement pattern and degree, presences of intralesional low attenuation and surface dimples or ulcers, LD/SD ratio, and attenuation value could help differentiating leiomyomas from GISTs in the gastric cardia, particularly in the manner of combination.
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Affiliation(s)
- Hyun Kyung Yang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
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Min YW, Park HN, Min BH, Choi D, Kim KM, Kim S. Preoperative predictive factors for gastrointestinal stromal tumors: analysis of 375 surgically resected gastric subepithelial tumors. J Gastrointest Surg 2015; 19:631-8. [PMID: 25472028 DOI: 10.1007/s11605-014-2708-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/14/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) and non-GIST subepithelial tumors (SETs) account for about 75 and 25% of gastric hypoechoic SETs ≥2 cm, respectively. Therefore, identifying preoperative predictive factors for GISTs are required to refine surgical indications. METHODS We performed a retrospective review of 375 surgically resected gastric hypoechoic SETs ≥2 cm. Demographic data and tumor characteristics based on upper endoscopy and CT findings were compared between GIST and non-GIST SETs originating from muscularis propria layer (leiomyomas, Schwannomas, glomus tumors, and ectopic pancreas). RESULTS In cardia, leiomyomas were found twice more frequently than GISTs (63.6 versus 31.8%). Perilesional lymph node enlargement (PLNE) was found only in patients with GIST or Schwannomas. Patients with GIST showed a significantly lower rate of PLNE than those with Schwannomas (3.5 versus 29.0%). In multivariate analysis, tumor site outside cardia (odds ratio, 9.157), absence of PLNE (odds ratio, 11.519), old age, large tumor size, exophytic growth pattern, and ulceration or dimpling were identified as independent preoperative predictive factors for GISTs versus non-GIST SETs. CONCLUSIONS The effort for preoperative pathologic diagnosis such as endosonography-guided tissue sampling might be positively considered for SETs at cardia and SETs with PLNE where the possibility of GIST is low.
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Affiliation(s)
- Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
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Tan TJ, Hayes MM, Radigan JP, Munk PL. Glomus tumour of the colon: dynamic contrast-enhanced CT findings and review of the literature. Clin Imaging 2015; 39:714-6. [PMID: 25770905 DOI: 10.1016/j.clinimag.2015.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 02/15/2015] [Accepted: 02/26/2015] [Indexed: 12/19/2022]
Abstract
We describe the peculiar enhancement pattern of a subepithelial colonic glomus tumour on dynamic contrast-enhanced computed tomography. Discontinuous, peripheral nodular enhancement of the colonic lesion followed by subsequent centripetal filling-in of contrast was reminiscent of a hepatic haemangioma, which has not been described with a glomus or any other subepithelial tumour of the colon. When encountered, this tumour enhancement pattern raises the possibility of a colonic glomus tumour prior to histological confirmation.
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Affiliation(s)
- Tien Jin Tan
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Malcolm M Hayes
- Department of Pathology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jordan P Radigan
- Department of Pathology, St. Joseph's General Hospital, Comox, BC, Canada
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Wang S, Ding C, Tu J. Malignant glomus tumor of the lung with multiple metastasis: a rare case report. World J Surg Oncol 2015; 13:22. [PMID: 25888833 PMCID: PMC4336763 DOI: 10.1186/s12957-014-0423-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 12/23/2014] [Indexed: 12/03/2022] Open
Abstract
Malignant glomus tumor, or glomangiosarcoma, is a very rare mesenchymal neoplasm that, when seen, occurs in visceral organs. Despite having histologic features of malignancy, these tumors usually do not metastasize. However, when metastasis occurs, this disease is often fatal. Our report presents the case of a 59-year-old female patient with a highly aggressive and widely metastatic glomus tumor of the lung.
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Affiliation(s)
- Saibin Wang
- Department of Pneumology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, 321000, Jinhua, China.
| | - Chuanbiao Ding
- Department of Internal Medicine, Jinhua Municipal Central Hospital Pan-an Branch, 1# Luoshan Road, Pan-an, 322300, China.
| | - Junwei Tu
- Department of Pneumology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, 321000, Jinhua, China.
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28
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Voltaggio L, Montgomery EA. Gastrointestinal tract spindle cell lesions--just like real estate, it's all about location. Mod Pathol 2015; 28 Suppl 1:S47-66. [PMID: 25560599 DOI: 10.1038/modpathol.2014.126] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/22/2014] [Accepted: 06/23/2014] [Indexed: 12/21/2022]
Abstract
Interpretation of gastrointestinal tract mesenchymal lesions is simplified merely by knowing in which anatomic layer they are usually found. For example, Kaposi sarcoma is detected on mucosal biopsies, whereas inflammatory fibroid polyp is nearly always in the submucosa. Gastrointestinal stromal tumors (GISTs) are generally centered in the muscularis propria. Schwannomas are essentially always in the muscularis propria. Mesenteric lesions are usually found in the small bowel mesentery. Knowledge of the favored layer is even most important in interpreting colon biopsies, as many mesenschymal polyps are encountered in the colon. Although GISTs are among the most common mesenchymal lesions, we will concentrate our discussion on other mesenchymal lesions, some of which are in the differential diagnosis of GIST, and point out some diagnostic pitfalls, particularly in immunolabeling.
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Affiliation(s)
- Lysandra Voltaggio
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Hu SD, Hu DM, Huang W, Chen KM, Song Q. Computed tomography and clinical characteristics of gastric glomus tumors. J Dig Dis 2014; 15:477-82. [PMID: 24980906 DOI: 10.1111/1751-2980.12172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To provide a retrospective assessment of clinical characteristics of the patients with gastric glomus tumors and the imaging features of the tumors on multidetector row computed tomography (MDCT). METHODS Consecutive patients with gastric glomus tumor which was confirmed by postoperative pathology from January 2004 to January 2012 in a tertiary hospital were included in the study. The MDCT images and medical records of the patients including the imaging features of the tumor on MDCT such as its location, number, shape, growth pattern, size, density and enhancement pattern were retrospectively reviewed. RESULTS Altogether ten patients were included in the study, including seven women and three men, with a mean age of 46.6 years (range 25-67 years). Most patients had nonspecific clinical symptoms. All lesions were located at the gastric antrum, with a mean diameter of 2.7 cm. The gastric glomus tumor showed strong enhancement at the arterial phase, a progressive filled-in enhanced pattern and prolonged enhancement during multiphasic scans. CONCLUSIONS Gastric glomus tumor is clinically an extremely rare disease. The combination of tumor location, size and the characteristic enhancement pattern of the subepithelial lesion may suggest a diagnosis of gastric glomus tumor.
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Affiliation(s)
- Shu Dong Hu
- Department of Radiology, Shanghai Jiaotong University School of Medicine, Shanghai; Department of Radiology, Affiliated Renmin Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
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30
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Kang HC, Menias CO, Gaballah AH, Shroff S, Taggart MW, Garg N, Elsayes KM. Beyond the GIST: mesenchymal tumors of the stomach. Radiographics 2014; 33:1673-90. [PMID: 24108557 DOI: 10.1148/rg.336135507] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Intramural gastric masses arise in the wall of the stomach (generally within the submucosa or muscularis propria), often with intact overlying mucosa. These tumors are typically mesenchymal in origin and have overlapping radiologic appearances. A combination of features such as location, attenuation, enhancement, and growth pattern may suggest one diagnosis over another. Gastrointestinal stromal tumors (GISTs) account for the majority of intramural tumors and can vary widely in appearance, from small intraluminal lesions to exophytic masses that protrude into the peritoneal cavity, commonly with areas of hemorrhage or necrosis. A well-circumscribed mass measuring -70 to -120 HU is a lipoma. Leiomyomas usually manifest as low-attenuation masses at the gastric cardia. Homogeneous attenuation is a noteworthy characteristic of schwannomas, particularly for larger lesions that might otherwise be mistaken for GISTs. A hypervascular mass in the antrum is a common manifestation of glomus tumors. Hemangiomas are also hypervascular but often manifest in childhood. Inflammatory fibroid polyps usually arise as a polypoid mass in the antrum. Inflammatory myofibroblastic tumors are infiltrative neoplasms with a propensity for local recurrence. Plexiform fibromyxomas are rare, usually antral tumors. Carcinoid tumors are epithelial in origin, but often submucosal in location, and therefore should be distinguished from other intramural lesions. Multiple carcinoid tumors are associated with hypergastrinemia, either in the setting of chronic atrophic gastritis or Zollinger-Ellison syndrome. Sporadic solitary carcinoid tumors not associated with hypergastrinemia have a higher rate of metastasis. Histopathologic analysis, including immunohistochemistry, is usually required for diagnosis of intramural masses.
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Affiliation(s)
- Hyunseon C Kang
- Departments of Diagnostic Radiology and Pathology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030; Department of Radiology, Mayo Clinic, Tucson, Ariz
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Choi YR, Kim SH, Kim SA, Shin CI, Kim HJ, Kim SH, Han JK, Choi BI. Differentiation of large (≥ 5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: radiologists' performance using CT. Eur J Radiol 2013; 83:250-60. [PMID: 24325848 DOI: 10.1016/j.ejrad.2013.10.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/19/2013] [Accepted: 10/30/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE To identify significant CT findings for the differentiation of large (≥ 5 cm) gastric gastrointestinal stromal tumors (GIST) from benign subepithelial tumors and to assess whether radiologists' performance in differentiation is improved with knowledge of significant CT criteria. MATERIALS AND METHODS One-hundred twenty patients with pathologically proven large (≥ 5 cm) GISTs (n=99), schwannomas (n=16), and leiomyomas (n=5) who underwent CT were enrolled. Two radiologists (A and B) retrospectively reviewed their CT images in consensus for the location, size, degree and pattern of enhancement, contour, growth pattern and the presence of calcification, necrosis, surface ulceration, or enlarged lymph nodes. CT findings considered significant for differentiation were determined using uni- and multivariate statistical analyses. Thereafter, two successive review sessions for the differentiation of GIST from non-GIST were independently performed by two other reviewers (C and D) with different expertise of 2 and 9 years using a 5-point confidence scale. At the first session, reviewers interpreted CT images without knowledge of significant CT findings. At the second session, the results of statistical analyses were provided to the reviewers. To assess improvement in radiologists' performance, a pairwise comparison of receiver operating curves (ROC) was performed. RESULTS Heterogeneous enhancement, presence of necrosis, absence of lymph nodes, and mean size of ≥ 6 cm were found to be significant for differentiating GIST from schwannoma (P<0.05). Non-cardial location, heterogeneous enhancement, and presence of necrosis were differential CT features of GIST from leiomyoma (P<0.05). Multivariate analyses indicated that absence of enlarged LNs was the only statistically significant variable for GIST differentiating from schwannoma. The area under the curve of both reviewers obtained using ROC significantly increased from 0.682 and 0.613 to 0.903 and 0.904, respectively, with information of the significant CT findings differentiating GISTs from non-GISTs (P<0.001). CONCLUSION Non-cardial location, heterogeneous enhancement, presence of necrosis, larger lesion size, and absence of lymphadenopathy are highly suggestive CT findings for large GISTs in differentiation from schwannomas or leiomyomas. Regardless of radiologists' expertise, diagnostic performance in differentiation can be significantly improved with knowledge of these CT findings.
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Affiliation(s)
- Ye Ra Choi
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea; The Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea.
| | - Sun-Ah Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Cheong-Il Shin
- Department of Radiology, Seoul National University Hospital, Republic of Korea; The Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
| | - Hyung Jin Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Seong Ho Kim
- Department of Radiology, Seoul National University Hospital, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Republic of Korea; The Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Republic of Korea; The Institute of Radiation Medicine, Seoul National University Hospital, Republic of Korea
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Nishida T, Kawai N, Yamaguchi S, Nishida Y. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc 2013; 25:479-89. [PMID: 23902569 DOI: 10.1111/den.12149] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/28/2013] [Indexed: 12/12/2022]
Abstract
Small submucosal tumors (SMT) without symptoms are frequently found by endoscopic and radiological examinations. To find proper diagnostic measures and therapeutic indications for histologically undiagnosed SMT, we reviewed published articles in PubMed between 1990 and March 2013 using the key words 'submucosal tumor' and the name of a specific disease. SMT is observed in a wide range of gastrointestinal (GI) diseases and conditions, including compression by extra-GI organs and lesions, congenital tumors, inflammation, and benign as well as malignant neoplastic lesions. In the diagnosis of diseases and decision-making for therapy, endoscopic ultrasonography (EUS) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) may play a key role. Symptomatic SMT and SMT histologically diagnosed as malignant or potentially malignant tumors such as gastrointestinal stromal tumor (GIST) should be treated by surgery. SMT >5 cm, SMT increasing in size and those with'high-risk features' including irregular border, heterogeneous internal echo such as anechoic area, and heterogeneous enhancement by contrast media may also be removed by surgery. Laparoscopic approach is feasible for gastric GIST <5 cm and this is considered less invasive than the open approach. Emerging techniques using flexible endoscopes appear less invasive, but require further evidence and are still under clinical study. Correct diagnosis of SMT is challenging; however, EUS and EUS-FNA are useful in the histological diagnosis and clinical decision-making. In the future, minimally invasive approaches may be a mainstream of surgical treatment for small SMT.
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Malignant glomus tumor (glomangiosarcoma) of intestinal ileum: a rare case report. Case Rep Pathol 2013; 2013:305321. [PMID: 23691399 PMCID: PMC3638502 DOI: 10.1155/2013/305321] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 03/22/2013] [Indexed: 01/18/2023] Open
Abstract
Glomus tumors are rare mesenchymal neoplastic lesions arising from glomus bodies that are involved in skin thermoregulation. They are mostly benign tumors, and malignant variants have been rarely reported. The subungual zones of fingers and toes are the most frequent sites of observation. Glomus tumors arising in visceral organs of the gastrointestinal tract are exceedingly rare. Stomach antrum and intestinal duodenum are the most frequent organs involved. No single case of glomus tumor involving intestinal ileum has been previously reported in the English medical literature. To the best of our knowledge, we report the first case of malignant glomus tumor (glomangiosarcoma) of intestinal ileum in a 29-year-old female patient who presented with a 1-month history of a tender pelvi-abdominal mass, constipation, vomiting, and melena. The intestinal ileum glomus tumor was resected, and histopathological diagnosis was consistent with glomangiosarcoma. A postoperative 6-month followup failed to show any evidence of tumor recurrence.
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