Role of Multimodality Imaging in Gastroesophageal Reflux Disease and Its Complications, with Clinical and Pathologic Correlation.

Gastroesophageal reflux disease (GERD) is a common condition and impairs the quality of life for millions of patients, accounts for considerable health care spending, and is a primary risk factor for esophageal adenocarcinoma. There have been substantial advances in understanding the pathogenesis of GERD and its complications and much progress in diagnosis and management of GERD; however, these have not been comprehensively discussed in the recent radiology literature. Understanding the role of imaging in GERD and its complications is important to aid in multidisciplinary treatment of GERD. GERD results from prolonged or recurrent reflux of gastric contents into the esophagus. Common symptoms include heartburn or regurgitation. Prolonged reflux of gastric contents into the esophagus can cause erosive esophagitis. Over time, the inflammatory response related to esophagitis can lead to deposition of fibrous tissue and development of strictures. Alternatively, the esophageal mucosa can undergo metaplasia (Barrett esophagus), a precursor to dysplasia (which can lead to adenocarcinoma). Conventional barium esophagography has long been considered the primary imaging modality for the esophagus, and the fluoroscopic findings for diagnosis of GERD have been well established. Multimodality imaging has a clear role in detection and assessment of the complications of GERD, specifically reflux esophagitis and Barrett esophagus; differentiation of benign and malignant strictures; and detection, staging, and posttreatment surveillance of esophageal adenocarcinoma. Given the dramatic changes in utilization of abdominal imaging during the past 2 decades, with significantly declining volume of fluoroscopic procedures and concomitant increase in CT and MRI studies, it is crucial that modern radiologists appreciate the value of barium esophagography in the workup of GERD and recognize the key imaging features of GERD and its complications at CT and MRI.

Primary Hepatic Neoplasms of Vascular Origin: Key Imaging Features and Differential Diagnoses With Radiology-Pathology Correlation.

OBJECTIVE: This article describes, illustrates, and correlates imaging and pathologic features of primary vascular mesenchymal neoplasms of the liver, which arise from the vascular endothelium and perivascular epithelioid cells. CONCLUSION: Familiarity with the spectrum of benign, malignant-potential and malignant vascular neoplasms, and nonneoplastic mimickers allows consideration in the differential diagnosis of enhancing hepatic masses. Understanding relevant pathologic features facilitates recognition of key imaging features, specifically dynamic contrast enhancement patterns on CT and MRI, which provide a useful classification system.

Gastrointestinal Lymphoma: Radiologic-Pathologic Correlation.

Extranodal lymphoma is a heterogeneous group of hematologic neoplasms that can affect every abdominal organ, with distinctive pathologic, radiologic, and clinical features. The radiologic findings are closely related to the underlying pathophysiology, and an understanding of these characteristic features should facilitate recognition of extranodal lymphoma and its various subtypes. Within the abdomen, lymphoma is found most commonly in the gastrointestinal tract, especially the stomach. This article presents the findings in gastrointestinal tract lymphoma.

From the radiologic pathology archives: gastrointestinal lymphoma: radiologic and pathologic findings.

Gastrointestinal (GI) lymphoma encompasses a heterogeneous group of neoplasms that have a common lymphoid origin but variable pathologic and imaging features. Extranodal marginal zone B-cell lymphoma (ENMZL) and diffuse large B-cell lymphoma (DLBCL) are the most common. ENMZL usually occurs in the stomach, where it is associated with chronic infection by Helicobacter pylori, and is typically a superficial spreading lesion that causes mucosal nodularity or ulceration and mild wall thickening. DLBCL may arise de novo or from transformation of ENMZL or other low-grade lymphomas. This form of lymphoma produces extensive wall thickening or a bulky mass, but obstruction is uncommon. Mantle cell lymphoma is the classic cause of lymphomatous polyposis, but multiple polyps or nodules can also be seen with ENMZL and follicular lymphoma. Burkitt lymphoma is usually characterized by an ileocecal mass or wall thickening in the terminal ileum in young children, often in the setting of widespread disease. Primary GI Hodgkin lymphoma, which is rare, may be manifested by a variety of findings, though stenosis is more common than with non-Hodgkin lymphoma. Enteropathy-associated T-cell lymphoma is frequently associated with celiac disease and is characterized by wall thickening, ulceration, and even perforation of the jejunum. Accurate radiologic diagnosis of GI lymphoma requires a multifactorial approach based on the clinical findings, site of involvement, imaging findings, and associated complications.

From the radiologic pathology archives: esophageal neoplasms: radiologic-pathologic correlation.

Esophageal neoplasms have a wide spectrum of clinical features, pathologic findings, and imaging manifestations. Leiomyomas are the most common benign esophageal neoplasm, typically appearing as smoothly marginated intramural masses. Fibrovascular polyps arise in the cervical esophagus, gradually elongating as they are pulled inferiorly by esophageal peristalsis. Granular cell tumors are generally incidental small intramural masses with an appearance similar to that of leiomyomas. Malignant esophageal neoplasms are a common cause of cancer mortality, particularly squamous cell carcinoma (SCC) and adenocarcinoma. Both of these tumors occur in older men, most often appearing as irregular infiltrative lesions at barium examination, with evidence of tumor spread beyond the esophagus at cross-sectional imaging. Adenocarcinoma arises from Barrett esophagus and is much more likely than SCC to involve the gastroesophageal junction. Esophageal involvement by lymphoma is usually secondary to tumor spread from the stomach or mediastinum. Spindle cell carcinoma is a biphasic malignancy with carcinomatous and sarcomatous elements that forms a bulky polypoid intraluminal mass. Neuroendocrine carcinoma is an aggressive neoplasm that may be hypervascular and is usually associated with metastatic disease at presentation. Understanding the imaging appearances and pathologic bases of esophageal neoplasms is essential for their detection, differential diagnosis, staging, and treatment planning.

Segmental atrophy of the liver: a distinctive pseudotumor of the liver with variable histologic appearances.

Segmental atrophy of the liver can lead to the formation of a pseudotumor that can pose a diagnostic challenge. To better understand the full clinicopathologic spectrum of this pseudotumor, 18 cases were studied. Ages at presentation ranged from 14 to 91 years (median, 63 y) with a modest female-patient predominance (13 of 18, 72%). Upper right quadrant abdominal pain was the most common clinical presentation (14 of 18, 78%), and all the cases were mass lesions. The majority of cases were subcapsular (15 of 18, 83%) and ranged in size from 1.8 to 10.0 cm. All the cases contained abnormally thick-walled and often thrombosed vessels, with both arteries and veins affected. Biliary cysts were a common finding (7 of 18, 39%). Examination of the entire series of cases suggested a sequence of changes, with early lesions (n = 4) composed of collapsed hepatic parenchyma with preservation of portal areas, occasional islands of residual hepatocytes, and brisk bile ductular proliferation. These cases showed very mild elastosis. Other cases (n = 10) showed little or no ductular proliferation but had increased levels of elastosis. More advanced lesions (n = 3) were composed almost solely of elastosis with small scattered islands of unremarkable hepatocytes, whereas an end-stage lesion (n = 1) was a discrete nodule of fibrosis. In conclusion, segmental atrophy of the liver is typically subcapsular, and is strongly associated with vascular injury. The lesion has multiple stages ranging from parenchymal collapse, to nodular elastosis, to nodular fibrosis. Recognizing the various morphologies will aid in proper diagnosis.

Brunner's gland hyperplasia and hamartoma: imaging features with clinicopathologic correlation.

OBJECTIVE: The purpose of this essay is to describe, illustrate, and correlate the imaging and pathologic features of Brunner's gland hyperplasia and Brunner's gland hamartoma. CONCLUSION: This article summarizes our experience with pathologically proven cases of Brunner's hyperplasia and hamartoma accessioned into the radiologic pathology archive of the Armed Forces Institute of Pathology.

From the archives of the AFIP: benign fibrous tumors and tumorlike lesions of the mesentery: radiologic-pathologic correlation.

Mesenteric fibromatosis, sclerosing mesenteritis, inflammatory pseudotumor, and extrapleural solitary fibrous tumor constitute a loosely associated group of benign fibrous tumors and tumorlike lesions of the mesentery. These lesions are linked histologically by the presence of fibroblasts or fibrosis and anatomically by their location within the mesentery. Although rare, and distinctly different in pathogenesis and biologic behavior, these fibrous lesions have pathologic and radiologic features that overlap with one another and with more common neoplastic and nonneoplastic lesions of the mesentery. Mesenteric fibromatosis is a locally aggressive, benign proliferative process that may occur sporadically or in association with familial adenomatous polyposis. It most frequently manifests as a focal mesenteric mass and may simulate lymphoma, metastatic disease, or a soft-tissue sarcoma. Sclerosing mesenteritis is a rare idiopathic disorder that most commonly produces a stellate mass within the mesentery and should be differentiated from metastatic disease, specifically metastatic carcinoid, because it frequently responds to conservative or medical management. Inflammatory pseudotumor (inflammatory myofibroblastic tumor) is a benign, chronic inflammatory disorder of unknown cause that manifests as a solid mesenteric mass, indistinguishable from malignancy. Extrapleural solitary fibrous tumor is a tumor of submesothelial origin that is identical to the solitary fibrous tumor of the pleura. When located in the mesentery or peritoneal cavity, extrapleural solitary fibrous tumor has an imaging pattern that must be differentiated from metastatic disease, soft-tissue sarcomas, and other benign and malignant neoplasms of the mesentery and peritoneum. Knowledge of this group of benign fibrous tumors and tumorlike lesions of the mesentery is important in the preoperative evaluation of a mesenteric mass.