imaging of gastrointestinal tract tumors978-3-642-83825-5/1.pdfimaging of gastrointestinal tract...
TRANSCRIPT
Jean-Noel Bruneton
Imaging of Gastrointestinal Tract Tumors In Collaboration with C. Balu-Maestro J. Drouillard A. Geoffray M.-Y. Mourou A. Rogopoulos G. Schmutz P.-J. Valette
Translated by N. Reed Rameau Foreword by J. Delmont
With 267 Figures and 25 Tables
Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong
Author
Dr. Jean-Noel Bruneton Service de Radiologie, Centre Antoine-Lacassagne 36, Voie Romaine, 06054 Nice Cedex, France
Translator
Nancy Reed Rameau Centre Antoine-Lacassagne 36, Voie Romaine, 06054 Nice Cedex, France
ISBN -13: 978-3-642-83827-9 e- ISBN -13: 978-3-642-83825-5 DOl: 10.1007/978-3-642-83825-5
Library of Congress Cataloging-in-Publication Data Bruneton, J. N. Imaging of gastrointestinal tract tumors/Jean-Noel Bruneton, in collaboration with C. Balu-Maestro ... let al.]; translated by N. Reed Rameau: foreword by 1. Delmont. p. cm. Includes bibliographical references. ISBN-l 3:978-3-642-83827-9 (U. S.) 1. Gastrointestinal system-Tumors-Imaging. l. Title. [DNLM: 1. Diagnostic Imaging. 2. Gastrointestinal Neoplasms-radiography. 3. Gastro-intestinal Neoplasms-radionuclide imaging. WI 149 B895i] RC280.D5B78 1990 616.99'4330754-dc20 DNLM/DLC 89-26287
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© Springer-Verlag Berlin Heidelberg 1990 Softcover reprint of the hardcover 1st edition 1990
The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
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2121/3140-543210 - Printed on acid-free paper.
The authors wish to thank Christine Rostagni and Frans;oise Fein for their assistance in the preparation of this book.
Foreword
This new book by Jean-Noel Bruneton demonstrates once more his numerous talents and expertise in both the practice and the teaching of radiology. Numerous readers will undoubtedly have the same pleasure I did from reading it straight through, from cover to cover, especially those chapters on topics not covered elsewhere, such as that on metastases of the gastrointestinal tract. Imaging of Gastrointestinal Tumors will be most highly valued as an atlas and a reference book; in this respect, it will prove of special interest to all radiologists and medical and surgical specialists in gastroenterology and occupy a privileged place in their library. As an atlas, the high quality illustrations are of outstanding exemplary value. The many young gastroenterologists who have entered the field since the rapid development of digestive endoscopy, and are less familiar with the interpretation of barium contrast films, will profit from the expertise of Jean-Noel Bruneton, who himself was privileged to work with the illustrious radiologist Paul Lecomte. A superb iconography has also been compiled covering the numerous state-of-the-art imaging techniques that have enriched modem radiology. As a practical reference book, the logical histopathologic approach and detailed index facilitate the location of information on topics of current interest, such as Kaposi's sarcomas in AIDS, and on such infrequent pathologies as aberrant pancreas and gastrointestinal endometriosis. When dealing with any gastrointestinal tract tumor, today's physician has two equally important and inseparable obligations: histologic diagnosis and tumor staging (local, regional, distant); such information is essential for evaluating tumor resectability, a major concern in the case of these lesions. Since a positive diagnosis of gastrointestinal tract tumors requires histopathologic confirmation, gastrointestinal endoscopy is of prime importance. The three-dimensional endoscopic view of the tumor in actual size and natural color can be likened to a gross histopathologic examination. By contrast, to use the terms of the renowned Parisian radiologist X. Porcher, barium contrast radiology is never more than the study of silhouettes (two-dimensional black and white images). Endoscopy also widens the possibilities for microscopic analysis of biopsy material. Although the use of biopsy forceps is often sufficient other stratagems are sometimes useful, especially for submucosal tumors, including serial biopsies at a given site, needle aspiration biopsy, macrobiopsies with an electrosurgical snare, and cytology brushes. The classic means of histology have been enriched by the advent of techniques such as immunofluorescence, and thanks to elec-
VIII Foreword
tron microscopy, the muscular origin of the "bizzare tumors" of Stout has been recognized since 1969 (P. Laffargue, H. Monges, J. Delmont (1969) Etude ultrastructurale d'une tumeur myoide de l'estomac. Annales d'Anatomie Pathologique 14: 295). Similarly, modern monoclonal antibody techniques (anticytokeratin antibodies for epithelial cancer, panleukocytic antibodies for malignant lymphomas, etc.) now facilitate classification of difficult cases. Until fairly recently, tumor staging was hampered by the fact that gastrointestinal endoscopy merely provided a "bird eye" view and was of no assistance in evaluating the depth of lesion penetration. Miniaturization of ultrasonic probes that can be inserted through fiberscope biopsy channels has partly overcome this problem and represents a link between modern radiology and gastroenterology. Other more specifically radiologic techniques continue to provide irreplaceable information, however, and ultrasonography, computed tomography, and MRI are all extensively reviewed in this excellent book by Jean-Noel Bruneton, which will soon undoubtedly become a classic.
Jean P. Delmont Hepato-gastroenterologist, Nice Regional Hospitals Vice-Dean, University of Nice Medical School
Contents
Benign Tumors ..
1
1.1 1.1.1 1.1.2
1.2 1.2.1 1.2.2 1.2.3
1.3 1.3.1 1.3.2 1.3.3
1.4 1.4.1 1.4.2 1.4.3 1.4.4
1.5
2
2.1 2.1.1 2.1.2
2.2 2.2.1 2.2.2 2.2.3
2.3
3
3.1 3.1.1 3.1.2
Benign Epithelial Tumors.
Esophagus .... General Features Imaging · .... Stomach · .... General Features Imaging · .... Differential Diagnosis.
Small Intestine . . General Features ... Imaging · ....... Differential Diagnosis.
Colon and Rectum General Features ... Imaging · ....... Differential Diagnosis. Conclusion .
References .......
Polyposis ....................... .
Hereditary Polyposis Syndromes. Familial Multiple Polyposis Other Hereditary Polypses . . . .
Non-hereditary Polyposes .... Proliferation of Hyperplastic Polyps . Cronkhite-Canada Syndrome Differential Diagnosis.
References . . . . . . . . . . .
Leiomyoma . ....
Esophagus .... General Features Imaging .....
3
3 3 3
4 4 5 5
6 6 7 8
8 8
10 13 13
14
17
17 17 21
23 23 23 23
24
26
26 26 27
X Contents
3.2 3.2.1 3.2.2
3.3 3.3.1 3.3.2
3.4 3.4.1 3.4.2
3.5 3.6
4
4.1 4.2 4.3 4.4 4.5 4.6
5
5.1
5.1.1 5.1.2
5.2
5.2.1 5.2.2
5.3
5.3.1 5.3.2
5.4
5.4.1 5.4.2
5.5 5.5.1 5.5.2
5.6
Stomach General Features Imaging · ....
Small Intestine . . General Features Imaging · ....
Colon and Rectum General Features Imaging · . Conclusion . References .
Lipoma . ......... .
General Anatomic Features Esophagus .. . Stomach ..... . Small Intestine . . . Colon and Rectum References . . ...
Benign Neurogenic Tumors
Neurogenic Gastric Tumors (Excluding von Recklinghausen's Disease) General Features Imaging .................. .
Neurogenic Intestinal Tumors (Excluding von Recklinghausen's Disease) General Features Imaging .................. .
Solitary Benign Neurogenic Tumors of the Esophagus, Colon, and Rectum Esophagus ....................... . Colon and Rectum .................. .
Benign Neurogenic Tumors in von Recklinghausen's Disease ......................... . Gastric Involvement by von Recklinghausen's Disease Intestinal Involvement by von Recklinghausen's Disease
Granular Cell Tumors. General Features Esophagus
References
28 28 28
31 31 31
34 34 34
34 35
38
38 38 39 40 43 44
47
47 47 48
50 50 51
52 52 52
54 54 54
55 55 56
56
6
6.1
6.2 6.2.1 6.2.2 6.2.3 6.2.4
6.3 6.4
7
7.1 7.2 7.3 7.4 7.5 7.6
8
8.1 8.2 8.3 8.4
9
9.1 9.2 9.3
Contents
Benign Vascular Tumors .....
General Features ....
Gastrointestinal Hemangiomas. Esophagus ... Stomach ...... Small Intestine . . . Colon and Rectum
Lymphangiomas. References . . . . .
Benign Fibrous Tumor Tissues . . . . . . . . . . . .
Esophagus .. . Stomach ... . Small Intestine . Colon and Rectum Conclusion . References . . . . .
Aberrant Pancreas
General Features Imaging .. Conclusion. References
Endometriosis.
General Features Imaging References ....
... . .. . .. . . .
..
Malignant Tumors. . . . . . . . . . .
10 Carcinoma of the Esophagus. .. . . . . . . . . . .
10.1 Pathology .. 10.1.1 Epidemiology 10.1.2 Pathogenesis .
10.2 Anatomic Features 10.2.1 Macroscopic Features . 10.2.2 Location ...... 10.2.3 Histology ...... 10.2.4 Patterns of Spread .
XI
60
60
61 61 61 61 62
63 64
65
65 66 66 66 67 67
68
68 70 71 71
73
73 74 75
77
79
79 79 79
80 80 81 81 81
XII Contents
10.2.5 Evolution. 10.2.6 TNM Classification
10.3 Clinical Symptoms and Endoscopy 10.3.1 Clinical Symptoms 10.3.2 Endoscopy ...... .
10.4 10.4.1 10.4.2 10.4.3 10.4.4 10.4.5
10.5
10.6 10.6.1 10.6.2 10.6.3
10.7
10.7.1 10.7.2 10.7.3 10.7.4 10.7.5
10.8 10.8.1 10.8.2
10.8.3
Diagnostic Imaging . . Standard Chest X-rays Barium Esophagography Computed Tomography. Ultrasonography. . Other Techniques
Prognostic Factors .
Therapeutic Options Surgery ....... . Radiotherapy ... . Local Palliative Therapy
Post-therapy Imaging Studies and Diagnosis of Complications ... Normal Postoperative Appearance Early Postoperative Complications Late Postoperative Complications . Surveillance After Radiotherapy . . Surveillance After Other Types of Treatment
Adenocarcinoma of the Esophagus . . . . . Radiographic Features . . . . . . . . . . . . Differences Between Adenocarcinoma and Epidermoid Cancer of the Esophagus . . . . . . . . . Adenocarcinoma of the Esophagus and Gastric Adenocarcinoma
10.9 Conclusion. 10.10 References.
82 82
82 82 83
83 83 83 87 92 95
96
97 97 97 98
98 98 98 99 99
100
100 100
102
102
102 102
11 Adenocarcinoma o/the Stomach. . . . . . . . . . . .. 107
11.1 Epidemiology 11.1.1 Frequency . .
11.2' Pathogenesis. 11.2.1 Endogenous Factors 11.2.2 Environmental Factors
11.3 11.3.1 11.3.2 11.3.3 11.3.4
Pathologic Findings . Gross Anatomy . . . Microscopic Features Mode of Spread . . . Classifications of Gastric Adenocarcinoma .
107 107
108 108 108
108 109 109 110 110
Contents XIII
11.4 11.4.1 11.4.2 11.4.3
11.5 11.5.1 11.5.2 11.5.3
11.6 11.6.1 11.6.2 11.6.3 11.6.4 11.6.5 11.6.6
11.7 11.7.1 11.7.2 11.7.3 11.7.4
Diagnostic Data Other than Imaging ... Circumstances of Discovery and Screening Clinical Symptoms Endoscopy ....
Imaging Studies . Contrast Studies . Ultrasonography. Computed Tomography.
Treatment and Prognosis Surgical Management of Gastric Adenocarcinoma. Radiotherapy Chemotherapy . . . Indications . . . .. Prognostic Factors . Survival ..... .
Patient Follow-up Clinical Pictures and Frequency of Complications Disease Recurrence . . . . . . . . . . . . . . . . . Follow-up Algorithm . . . . . . . . . ...... . Imaging Studies for Follow-up of Patients with Gastric Adenocarcinoma ..
11.8 Cancer of the Cardia 11.8.1 General Features 11.8.2 Imaging ..
11.9 Conclusion. 11.1 0 References.
12
12.1 12.2 12.3 12.4
13
13.1 13.1.1 13.1.2 13.1.3 13.1.4 13.1.5 13.1.6
13.2 13.2.1 13.2.2 13.2.3
Adenocarcinoma of the Small Intestine . ...... .
General Features Imaging .. Conclusion. References .
Adenocarcinoma of the Colon and Rectum . . . . . .
General Features .. Epidemiology . . . . Pathologic Anatomy. Clinical Study . . . . Diagnosis by Non-imaging Techniques Therapeutic Options ......... . Results and Prognosis . . . . . . . . . .
Pretherapy Staging of Colorectal Adenocarcinomas Barium Enema Examination Ultrasonography. . . . . Computed Tomography. . .
111 111 111 111
112 112 116 118
120 120 120 121 121 121 121
121 121 122 122
122
124 124 125
126 126
130
130 131 136 136
138
138 138 139 141 141 142 143
144 144 149 151
XIV Contents
13.3 Post-therapy Follow-up . ........ 155 13.3.1 Post-therapy Follow-up Examinations. 156 13.3.2 Anterior Resection · ..... 157 13.3.3 Abdominoperineal Resection. 158 13.3.4 Pelvic Exenteration · .. 163 13.3.5 Hepatic Metastases · ..... 164 13.3.6 Non-curative Treatment .... 165
13.4 Screening for Colorectal Cancer 165 13.4.1 Occult Fecal Blood Tests 166 13.4.2 High-risk Patients 167
13.5 References . . . . . . .. 167
14 Cancer of the Anal Canal ................ 174
14.1 Epidemiology 174
14.2 Pathogenesis . . 174 14.2.1 Gross Features . 174 14.2.2 Histology .... 174 14.2.3 Mode of Spread 174 14.2.4 Histoprognosis . 175
14.3 Clinical Features 175 14.4 Imaging · .. 175
14.5 Treatment .. 176 14.5.1 Radiotherapy 176 14.5.2 Surgery .... 177 14.5.3 Therapeutic Options 177 14.5.4 Post-therapy Follow-up . 177
14.6 Conclusion . 177 14.7 References . . . . . ... 179
15 Leiomyosarcoma ..................... 180
15.1 Esophagus .... 180 15.1.1 General Features 180 15.1.2 Imaging · .... 182
15.2 Stomach · .... 183 15.2.1 General Features 183 15.2.2 Imaging · .... 184
15.3 Small Intestine . . 187 15.3.1 General Features 187 15.3.2 Imaging · .... 188
15.4 Colon and Rectum 188 15.4.1 General Features 188
Contents XV
15.4.2 Imaging .. 189
15.5 Conclusion. 15.6 References.
16 Lymphomas . ........
16.1 Non-Hodgkin's Lymphoma 16.1.1 Esophagus ... 16.1.2 Stomach · ..... 16.1.3 Small Intestine . . . 16.1.4 Colon and Rectum
16.2 Hodgkin's Disease. 16.2.1 Esophagus ... 16.2.2 Stomach · ..... 16.2.3 Small Intestine . . . 16.2.4 Colon and Rectum
16.3 Conclusion. 16.4 References .
17 Metastases
17.1 Esophagus ...... 17.1.1 Clinical Features · . 17.1.2 Radiologic Features .
17.2 Stomach · ...... 17.2.1 Clinical Features · . 17.2.2 Radiologic Features .
17.3 Small Intestine . . . . 17.3.1 Clinical Features · . 17.3.2 Radiologic Features .
17.4 Colon and Rectum 17.4.1 Clinical Features · . 17.4.2 Radiologic Features .
17.5 Conclusion . 17.6 References .
18 Kaposi's Sarcoma
18.1 General Features 18.2 Imaging. 18.3 References ....
...............
189 190
193
193 194 194 199 203
206 206 206 207 208
208 208
213
213 214 214
215 217 217
218 219 219
224 224 224
225 225
230
230 230 232
XVI Contents
19 Malignant Neurogenic Tumors. 234
19.1 Stomach (Excluding von Recklinghausen's Disease) . 234 19.1.1 General Features 234 19.1.2 Imaging ......................... 235
19.2 Small Intestine (Excluding von Recklinghausen's Disease)
19.2.1 General Features 19.2.2 Imaging .................. .
19.3 Malignant Neurogenic Tumors in von Recklinghausen's
235 235 236
Disease . . 236 19.4 References.......................... 237
Primary Malignant Melanoma of the Gastrointestinal Tract. . . . . . .. ... . . . . . . . . . . . . . 239
20.1 Pathology 239 20.2 General Features . 239 20.3 Gastrointestinal Sites 239 20.4 Primary Melanoma of the Esophagus 240 20.5 Anorectal Melanoma 241 20.6 Conclusion . 242 20.7 References...... 242
21 Malignant Fibrous Histiocytoma. . . . . . . . . . .. 244
21.1 General Features 244 21.2 Imaging.. 245 21.3 Conclusion. 246 21.4 References. 247
Tumors with an Indeterminate Prognosis 249
22 Carcinoid Tumors. 251
22.1 General Features 251 22.1.1 Gross Features .. 251 22.1.2 Clinical Features 252 22.1.3 Diagnosis by Techniques Other than Imaging 252 22.1.4 Evolution and Prognosis 252
22.2 Imaging .... 252 22.2.1 Small Intestine . 252 22.2.2 Rectum. 256 22.2.3 Colon ...... 257 22.2.4 Stomach .... 257 22.2.5 Other Anatomic Sites 258
Contents XVII
22.3 Conclusion . 258 22.4 References 258
23 Leiomyoblastoma . .. . .. . . . . 261
23.1 Stomach · .... 261 23.1.1 General Features 261 23.1.2 Imaging · .... 262
23.2 Extragastric Sites 265 23.3 References .... 265
24 H emangiopericytoma . .... . . . . . . 268
24.1 General Features 268 24.2 Imaging · . 269 24.3 Conclusion . 270 24.4 References 270
25 Subject Index . ... . ... . . . .. 272
Collaborators
Catherine Balu-Maestro Service de Radiologie, Centre Antoine-Lacassagne 36, Voie Romaine, 06054 Nice Cedex, France
Jacques Drouillard Service de Radiologie, Hopital du Haut Leveque Avenue Magellan, 33600 Pessac, France
Anne Geoffray Service de Radiologie, Centre Antoine-Lacassagne 36, Voie Romaine, 06054 Nice Cedex, France
Michel-Yves Mourou Service de Tomodensitometrie, Hopital Princesse Grace Avenue Pasteur, 98000 Principaute de Monaco
Andre Rogopoulos Service de Radiologie, Centre Antoine-Lacassagne 36, Voie Romaine, 06054 Nice Cedex, France
Gerard Schmutz Service de Radiologie Medico-Chirurgicale B, Hopital Central 1, Place de l'Hopital, 67091 Strasbourg Cedex, France
Pierre-Jean Valette Service de Radiologie, Hopital Edouard Herriot Place d'Arsonval, 69374 Lyon Cedex 03, France