Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Radiologic Review of Small Bowel Malignancies and Their Mimicking Lesions

소장의 악성 종양과 악성 종양으로 오인할 수 있는 소장 병변에 대한 영상의학적 검토

  • Jong Soo Lee (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • So Hyun Park (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Seung Joon Choi (Department of Radiology, Gil Medical Center, Gachon University College of Medicine)
  • 이종수 (가천대학교 의과대학 길병원 영상의학과) ;
  • 박소현 (가천대학교 의과대학 길병원 영상의학과) ;
  • 최승준 (가천대학교 의과대학 길병원 영상의학과)
  • Received : 2021.10.20
  • Accepted : 2022.04.19
  • Published : 2023.01.01
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Abstract

Because of their small size, small bowel malignancies are often easily missed when radiologists read CT images, which can lead to errors in the normal small bowel due to their similar enhancement to the small bowel or non-specific enhancement. In addition, small bowel malignancies are sometimes mistaken for masses of other origins, such as the uterus, rectum, or omentum. In this article, we describe various small-bowel malignancies, their mimicking lesions and the typical and atypical features on CT imaging along with their clinical manifestations.

영상의학과 의사가 컴퓨터단층촬영 영상을 볼 때, 소장에 생긴 악성 병변은 그 크기가 작아 정상 소장과 유사한 조영증강을 보이거나 비특이적인 조영증강으로 인해 정상 소장으로 오인될 수 있기 때문에 놓치기 쉽다. 또한, 소장의 악성 병변은 자궁, 직장, 대망과 같은 다른 장기에서 발생한 종괴로 오인될 수 있다. 이 임상화보에서, 저자들은 소장에 생긴 다양한 악성 종양과 악성 종양으로 오인할 수 있는 소장 병변의 전형적, 비전형적 CT 소견을 임상 양상과 함께 보여주고자 한다.

Keywords

References

  1. Hong S, Won YJ, Park YR, Jung KW, Kong HJ, Lee ES. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2018. Cancer Res Treat 2021;53:301-315 https://doi.org/10.4143/crt.2021.291
  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30 https://doi.org/10.3322/caac.21332
  3. Jasti R, Carucci LR. Small bowel neoplasms: a pictorial review. Radiographics 2020;40:1020-1038 https://doi.org/10.1148/rg.2020200011
  4. Maglinte DD, O'Connor K, Bessette J, Chernish SM, Kelvin FM. The role of the physician in the late diagnosis of primary malignant tumors of the small intestine. Am J Gastroenterol 1991;86:304-308
  5. Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M. Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 2003;23:283-304, 456; quiz 532 https://doi.org/10.1148/rg.232025146
  6. Gasparotto D, Rossi S, Campagna D, Scavina P, Tiziano FD, Marzotto A, et al. Imatinib-sensitizing KIT mutation in a Carney-Stratakis-associated GI stromal tumor. J Clin Oncol 2016;34:e99-e103 https://doi.org/10.1200/JCO.2012.44.7300
  7. DynaMed. Gastrointestinal stromal tumor (GIST). Available at. https://www.dynamed.com/topics/dmp~AN~T219072/Gastrointestinal-stromal-tumor-GIST. Published 2018. Accessed October 13, 2021
  8. Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet 2013;382:973-983 https://doi.org/10.1016/S0140-6736(13)60106-3
  9. Jang SH, Kwon JE, Kim JH, Lee JY, Kim SG, Kim JS, et al. Prediction of tumor recurrence in patients with non-gastric gastrointestinal stromal tumors following resection according to the modified National Institutes of Health criteria. Intest Res 2014;12:229-235 https://doi.org/10.5217/ir.2014.12.3.229
  10. Hong X, Choi H, Loyer EM, Benjamin RS, Trent JC, Charnsangavej C. Gastrointestinal stromal tumor: role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. Radiographics 2006;26:481-495 https://doi.org/10.1148/rg.262055097
  11. Kong SH, Yang HK. Surgical treatment of gastric gastrointestinal stromal tumor. J Gastric Cancer 2013;13:3-18 https://doi.org/10.5230/jgc.2013.13.1.3
  12. Pedersen KS, Raghav K, Overman MJ. Small bowel adenocarcinoma: etiology, presentation, and molecular alterations. J Natl Compr Canc Netw 2019;17:1135-1141 https://doi.org/10.6004/jnccn.2019.7344
  13. Qubaiah O, Devesa SS, Platz CE, Huycke MM, Dores GM. Small intestinal cancer: a population-based study of incidence and survival patterns in the United States, 1992 to 2006. Cancer Epidemiol Biomarkers Prev 2010;19:1908-1918 https://doi.org/10.1158/1055-9965.EPI-10-0328
  14. Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J. Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer 2004;101:518-526 https://doi.org/10.1002/cncr.20404
  15. Halfdanarson TR, McWilliams RR, Donohue JH, Quevedo JF. A single-institution experience with 491 cases of small bowel adenocarcinoma. Am J Surg 2010;199:797-803 https://doi.org/10.1016/j.amjsurg.2009.05.037
  16. Amin MB, Edge SB, Greene FL. AJCC cancer staging manual. 8th ed. New York: Springer 2017
  17. Hatzaras I, Palesty JA, Abir F, Sullivan P, Kozol RA, Dudrick SJ, et al. Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry. Arch Surg 2007;142:229-235 https://doi.org/10.1001/archsurg.142.3.229
  18. DiSario JA, Burt RW, Vargas H, McWhorter WP. Small bowel cancer: epidemiological and clinical characteristics from a population-based registry. Am J Gastroenterol 1994;89:699-701
  19. Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol 2011;17:697-707 https://doi.org/10.3748/wjg.v17.i6.697
  20. Lo Re G, Federica V, Midiri F, Picone D, La Tona G, Galia M, et al. Radiological features of gastrointestinal lymphoma. Gastroenterol Res Pract 2016;2016:2498143
  21. Ghai S, Pattison J, Ghai S, O'Malley ME, Khalili K, Stephens M. Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics 2007;27:1371-1388 https://doi.org/10.1148/rg.275065151
  22. Zhang TY, Lin Y, Fan R, Hu SR, Cheng MM, Zhang MC, et al. Potential model for differential diagnosis between Crohn's disease and primary intestinal lymphoma. World J Gastroenterol 2016;22:9411-9418 https://doi.org/10.3748/wjg.v22.i42.9411
  23. Han YE, Chae SY, Lee JH, Park BJ, Sung DJ, Han NY, et al. A rare case of small bowel undifferentiated pleomorphic sarcoma: imaging findings on CT and magnetic resonance enterography. J Korean Soc Radiol 2019;80:122-128 https://doi.org/10.3348/jksr.2019.80.1.122
  24. Tolman CJ. A rare case of small bowel leiomyosarcoma presenting with acute gastro-intestinal bleeding. BJR Case Rep 2017;3:20160089
  25. Lopes da Silva R. Extramedullary plasmacytoma of the small intestine: clinical features, diagnosis and treatment. J Dig Dis 2012;13:10-18 https://doi.org/10.1111/j.1751-2980.2011.00544.x
  26. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934-959 https://doi.org/10.1002/cncr.11105
  27. Sahani DV, Bonaffini PA, Fernandez-Del Castillo C, Blake MA. Gastroenteropancreatic neuroendocrine tumors: role of imaging in diagnosis and management. Radiology 2013;266:38-61 https://doi.org/10.1148/radiol.12112512
  28. Thakker RV. Multiple endocrine neoplasia--syndromes of the twentieth century. J Clin Endocrinol Metab 1998;83:2617-2620 https://doi.org/10.1210/jc.83.8.2617
  29. Baxi AJ, Chintapalli K, Katkar A, Restrepo CS, Betancourt SL, Sunnapwar A. Multimodality imaging findings in carcinoid tumors: a head-to-toe spectrum. Radiographics 2017;37:516-536 https://doi.org/10.1148/rg.2017160113
  30. Sundin A, Vullierme MP, Kaltsas G, Plockinger U; Mallorca Consensus Conference participants; European Neuroendocrine Tumor Society. ENETS consensus guidelines for the standards of care in neuroendocrine tumors: radiological examinations. Neuroendocrinology 2009;90:167-183 https://doi.org/10.1159/000184855
  31. Xavier S, Rosa B, Cotter J. Small bowel neuroendocrine tumors: from pathophysiology to clinical approach. World J Gastrointest Pathophysiol 2016;7:117-124 https://doi.org/10.4291/wjgp.v7.i1.117
  32. Levy AD, Sobin LH. From the archives of the AFIP: gastrointestinal carcinoids: imaging features with clinicopathologic comparison. Radiographics 2007;27:237-257 https://doi.org/10.1148/rg.271065169
  33. Macari M, Faust M, Liang H, Pachter HL. CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management. Clin Radiol 2007;62:73-77 https://doi.org/10.1016/j.crad.2006.09.014
  34. Bennett GL, Birnbaum BA, Balthazar EJ. CT of Meckel's diverticulitis in 11 patients. AJR Am J Roentgenol 2004;182:625-629 https://doi.org/10.2214/ajr.182.3.1820625
  35. 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. Abdom Imaging 2015;40:2159-2166 https://doi.org/10.1007/s00261-015-0431-y
  36. Al-Zarouni N, Al-Ozaibi L, Khammas A, Al-Suwaidi N, Al-Mazroui A, Al-Badri F. Traumatic jejunal hematoma in childhood-A case report and review of literature. Int J Surg Case Rep 2016;29:56-58 https://doi.org/10.1016/j.ijscr.2016.10.055
  37. Abbas MA, Collins JM, Olden KW, Kelly KA. Spontaneous intramural small-bowel hematoma: clinical presentation and long-term outcome. Arch Surg 2002;137:306-310 https://doi.org/10.1001/archsurg.137.3.306
  38. Abbas MA, Collins JM, Olden KW. Spontaneous intramural small-bowel hematoma: imaging findings and outcome. AJR Am J Roentgenol 2002;179:1389-1394 https://doi.org/10.2214/ajr.179.6.1791389
  39. Gourtsoyiannis NC, Bays D, Malamas M, Barouxis G, Liasis N. Radiological appearances of small intestinal leiomyomas. Clin Radiol 1992;45:94-103 https://doi.org/10.1016/S0009-9260(05)80063-7
  40. Kung JW, Brown A, Kruskal JB, Goldsmith JD, Pedrosa I. Heterotopic pancreas: typical and atypical imaging findings. Clin Radiol 2010;65:403-407 https://doi.org/10.1016/j.crad.2010.01.005