Primary extrapulmonary small cell carcinoma involving the stomach or duodenum or both: findings on CT and barium studies.

OBJECTIVE: The purpose of this study was to evaluate the CT and radiographic features of extrapulmonary small cell carcinoma involving the stomach or duodenum or both. CONCLUSION: Although the radiologic findings of extrapulmonary small cell carcinoma involving the stomach or duodenum or both appear to be variable and nonspecific, some distinguishing features are poor contrast enhancement, bulky exophytic mass, and minimal peritumoral infiltration.

[Computerized tomography findings in intestinal carcinoid]. / Aspetti del carcinoide intestinale con tomografia computerizzata.

INTRODUCTION: We studied the CT patterns of abdominal carcinoid tumors. MATERIAL AND METHODS: Eight patients with carcinoid tumors were examined with CT. The tumors were in the ileum (2 patients), duodenum (1), colon (1), and mesentery (4). Pathologic confirmation was obtained at surgery in all patients. The symptoms were the carcinoid syndrome in 2 patients, abdominal pain in 4, jaundice in 1 patient and a right lower quadrant mass in 1. All patients were examined with(out) i.v. contrast agent administration; 6 patients received oral contrast material and 2 were submitted to water enema, to enhance visualization of the distal ileum and colon. RESULTS: CT identified the tumor in all patients but correctly defined its site in 7 cases only. CT showed a small mass in the distal common bile duct in 1 case, which postoperative histology diagnosed as a malignant carcinoid tumor of the duodenum. The CT findings of carcinoid tumors were a rounded mesenteric mass displacing bowel loops in 4 cases, an infiltrating colonic tumor in 1 case, an apparently intracholedochal mass in 1, a large necrotic mesenteric mass in 1 case. CT showed lymph node involvement in 2 cases, but no liver metastases were found. A carcinoid tumor was diagnosed in 4 patients based on the typical CT finding of a mesenteric mass with radiating soft-tissue density bands resulting in a stellate pattern. No preoperative diagnosis was possible in some other cases because the CT patterns were aspecific and mimicked those of other lesions, namely of tumor of the distal common bile duct, adenocarcinoma of the right colon, submucosal tumor of the distal ileum, large necrotic mesenteric mass. CONCLUSIONS: CT is a useful tool in the detection of carcinoid tumors. The correct diagnosis can be made based on the characteristic CT finding of a rounded mesenteric mass. In our experience, however, carcinoid tumors may present with other CT patterns mimicking those of other tumors.

[Contribution of imaging in malignant non-Hodgkin lymphomas of the small intestine. Apropos of 32 cases]. / Apport de l'imagerie dans les lymphomes malins non hodgkiniens du grêle. A propos de 32 cas.

The authors report a retrospective study concerning 32 cases of non Hodgkin lymphoma of the small intestine, histologically confirmed. All patients underwent digestive opacification. Ultrasonography was performed in 15 cases and CT scan was performed in 6 cases. The average age was 36 years and the sex-ratio was 3.4. The classical radiological signs described in the literature were found in our patients. The diagnosis of lymphoma was easily suggested in the presence of polymorphic and multifocal lesions, and especially the aneurysmal appearance. Abdominal sonography and computed tomography contributed to the diagnosis and also helped to relate an abdominal mass to its digestive origin, by showing a classical "sandwich" appearance.

[Fortuitous discoveries of digestive tract tumors during the evaluation of hepatic tumors by lipiodol intra-arterial injection. Diagnostic application in a case of pancreatic tumor]. / Découvertes fortuites de tumeurs du tube digestif lors de bilan de tumeurs hépatiques par injection intra-artérielle lipiodolée. Application diagnostique dans un cas de tumeur pancréatique.

The authors report three cases of extrahepatic lipiodol enhancement: two fortuitous discoveries of gastric and duodenal leiomyomas during the management of malignant hepatic lesion and a pancreatic surgical detection of an insulinoma which had not been detected with conventional techniques. The principles of the technique are described. The basis of its application to the pancreatic region is purposed and the future developments of pancreatic studies are discussed.

Double-contrast hypotonic duodenography after enteroclysis.

The authors describe a technique for obtaining a double-contrast hypotonic duodenogram after a small-bowel enema examination. They have used this technique successfully in patients with unexplained gastrointestinal bleeding and to assess duodenal involvement in patients with Crohn's disease.

[Primary lymphoma of the small intestine. Radiographic image of enteroclysis with double-contrast media]. / Linfomi primitivi dell'intestino tenue. Aspetto radiografico nell'enteroclisi a doppio mezzo di contrasto.

The authors retrospectively reviewed the radiographic (double-contrast small-bowel enema) examinations of 20 patients with primitive small intestinal lymphomas. The diagnosis was histologically confirmed in all cases. The technique was very sensitive (100%) in detecting small-bowel abnormalities. On the contrary, a definite differential diagnosis was difficult to make (65%), except for 4 cases of lymphoma complicating celiac disease in which the presence of a nodular pattern and of thickened and irregular mucosal folds seemed to be highly specific. The most difficult differential diagnosis was with Crohn's disease. In all the cases with surgical confirmation (17), disease extent exactly corresponded to that suggested by small-bowel enema. Primitive small intestinal lymphoma is not radiologically distinguishable from secondary involvement during systemic lymphoma. From the analysis of radiological abnormalities, the authors observed that, different from previous reports, severe luminal narrowing was frequent, whereas "aneurysmal" dilatations of intestinal loops were never observed. CT was confirmed as the best technique for staging. Clinical implications of double-contrast enema in the diagnosis of primitive small intestinal lymphomas are discussed; radiographic patterns are reviewed.

Double contrast small bowel enema in a case of selective duodeno-jejunal amyloidosis.

Double contrast small bowel enema in a patient with selective amyloidosis of the duodenum and jejunum revealed an unusual radiologic pattern, mimicking multiple polyposis. Many submucosal polypoid lesions, sessile or pedunculated, were scattered throughout the duodenum and proximal jejunum. The lesions had smooth borders and did not show any retraction at the base. Other typical radiologic patterns of intestinal amyloidosis described in the literature were not observed in the present case. Differential diagnosis from multiple polyposis and diffuse lymphoproliferative neoplastic diseases is discussed.

[Radiological aspects of intestinal lipomas]. / Aspetti radiologici dei lipomi intestinali.

The radiological detection of intestinal lipomas is not unusual; however, in-depth studies of their radiological features have never been carried out, so far. Eighteen cases of intestinal lipoma were observed, out of different clinical histories. Through a careful survey of these cases, the authors describe the semiological characteristics of the lipomas, which were studied with radiographic contrast examinations of the small intestine and colon. In most cases the characteristics of the mass and--when present--the even more revealing features of its pedicle allowed the identification of such expansive lesions as lipomas. In some lesions detected by means of conventional methods CT proved extremely useful in diagnosing the nature of the lipomas. Such a diagnosis is extremely useful for it allows extensive surgery to be avoided and replaced with less extensive procedures--e.g. endoscopic removal of the lesion, or no specific treatment at all.

Radiological findings in small-bowel tumours.

Radiological findings were evaluated in a series of 25 cases with malignant and three with benign small bowel tumours with surgical or autopsy confirmation of diagnosis. 27 patients were operated, two of them without any radiography due to 'acute abdomen'. 23 patients were examined with ultrasound, 14 with barium examination, seven with CT, four with plain films and two with angiography. Ultrasound revealed 16 (70%) out of 23 tumours, in two cases result was abnormal but the tumour was not found and in five cases no abnormality was identified. Eleven barium examinations (78%) showed signs of tumour, one showed signs of occlusion but not the tumour and in two cases no abnormality was found. The tumour was seen in six of seven cases examined with CT. Our results proved that US is useful as screening study. Barium studies are needed for exact location of the tumour and in US negative cases.