Value of barium studies for predicting primary versus secondary non-Hodgkin's gastrointestinal lymphoma.

BACKGROUND: To determine the predictive value of a single lesion versus multifocal disease for differentiating primary and secondary gastrointestinal (GI) lymphoma on barium studies. METHODS: Our study group consisted of 90 cases of non-Hodgkin's GI lymphoma from the radiologic archives of the Armed Forces Institute of Pathology in which barium studies had been performed. Each of those studies was reviewed jointly by two of the authors to determine in a blinded fashion whether the patients had a single lesion or multifocal disease (defined as two or more discrete lesions). Medical and pathologic records were then reviewed to determine whether these patients had primary (defined as lymphoma arising in the GI tract) or secondary (defined as disseminated lymphoma with associated GI tract involvement) GI lymphoma. The final clinical diagnosis was then correlated with the radiographic findings to test the hypothesis that a single lesion is more likely to be associated with primary GI lymphoma and that multifocal disease is more likely to be associated with secondary GI lymphoma. RESULTS: Sixty-eight patients had a single lesion in the GI tract on barium studies; 52 (76%) of these patients had primary GI lymphoma and 16 (24%) had secondary GI lymphoma. Another 22 patients had multifocal disease on barium studies; 20 (91%) of these patients had secondary GI lymphoma and two (9%) had primary GI lymphoma. CONCLUSION: The predictive value of a single lesion for primary GI lymphoma on barium studies was 76%, and the predictive value of multifocal disease for secondary GI lymphoma was 91%. Thus, our data suggest that it is often possible to differentiate these two forms of GI lymphoma on the basis of the radiographic findings.

Primary malignant melanoma of the esophagus: radiographic findings in seven patients.

PURPOSE: To evaluate the radiographic findings in a series of patients with primary malignant melanoma of the esophagus. MATERIALS AND METHODS: Seven cases of primary esophageal melanoma were collected from the Hospital of the University of Pennsylvania and the radiologic archives of the Armed Forces Institute of Pathology. All patients underwent esophagography (double-contrast esophagograms in four patients, single-contrast esophagograms in three patients). Medical, endoscopic, and pathology reports were also reviewed. RESULTS: Six patients presented with dysphagia (average duration, 5 months). The remaining patient had recent onset of melena. In all patients, barium studies revealed bulky, polypoid intraluminal masses that focally expanded the esophagus without causing obstruction. The tumors were located in the distal third of the thoracic esophagus in four patients, the middle third in two, and the proximal third in one. Tumor pigmentation was noted at endoscopy in only one patient. All patients underwent extensive esophageal resection. Of four patients with clinical follow-up findings, two were alive and well 2 and 6 months after surgery; the other two had metastases to the lung and liver within 2 months of surgery. CONCLUSION: Primary esophageal melanomas have strikingly similar barium study findings, appearing as bulky, polypoid intraluminal masses that focally expand the esophagus without causing obstruction. Despite its rarity, primary esophageal melanoma should be considered when characteristic findings are present on barium studies.

Gastric mucosa-associated lymphoid tissue lymphoma: radiographic findings in six patients.

PURPOSE: To determine the radiographic findings of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma on double-contrast upper gastrointestinal studies. MATERIALS AND METHODS: Pathology records, double-contrast upper gastrointestinal studies, and medical records of six patients with gastric MALT lymphoma were retrospectively reviewed. RESULTS: The most common clinical findings at presentation included epigastric pain (n = 6), dyspepsia (n = 4), and nausea and vomiting (n = 4). Double-contrast studies revealed rounded, often confluent nodules of varying size in four patients with low-grade MALT lymphoma. Nodularity was located in the gastric antrum (n = 2), body (n = 1), or body and fundus (n = 1). A fifth patient had a malignant-appearing 1-cm-diameter antral ulcer, and a sixth had a 10-cm-diameter polypoid, ulcerated mass in the gastric fundus. The latter patient was found to have high-grade MALT lymphoma with low-grade MALT lymphoma abutting the tumor. Five patients had associated Helicobacter pylori gastritis. Five patients had stage I disease, and one had stage IIB disease. At endoscopic follow-up (n = 4), marked regression of tumor occurred after treatment with antibiotics, chemotherapy, and/or radiation therapy. CONCLUSION: When low-grade MALT lymphoma is suspected on the basis of barium study results, endoscopic biopsy specimens should be obtained for a definitive diagnosis so these patients can be treated before the development of high-grade gastric lymphoma.

Myofibroblastoma associated with bilateral gynecomastia: a case report and literature review.

Myofibroblastoma of the breast is a recently recognized benign mesenchymal mammary tumor that typically occurs as a unilateral, solitary lesion. Myofibroblastomas are well-circumscribed, unencapsulated tumors characterized by spindle cells in fascicles which exhibit varying degrees of myogenic and fibroblastic differentiation. Our case reports a mammary myofibroblastoma occurring in an 82-year-old male with gynecomastia and reviews the reported incidence of this benign spindle cell tumor in the world literature.