Diagnosis Of Submucosal Tumors Research Articles

Endoscopic Ultrasonography in the Diagnosis of Submucosal Tumors: Need for Biopsy

Endoscopic Ultrasonography in the Diagnosis of Submucosal Tumors: Need for Biopsy

Diagnosis of Submucosal Tumors (SMTs) in the Upper Gastrointestinal Tract by Endoscopic Ultrasonography (Part 2)

Diagnosis of Submucosal Tumors (SMTs) in the Upper Gastrointestinal Tract by Endoscopic Ultrasonography (Part 2)

Inflammatory fibroid polyp of the stomach. Report of three unusual cases.

Three patients with inflammatory fibroid polyp (IFP) of the stomach underwent operation with a diagnosis of submucosal tumor, polyp, and intramural tumor of the stomach, respectively. Resected specimens grossly showed a deep ulcer accompanied by surrounding upheaval, a sausagelike polyp 6.5 cm long, and a pedunculated tumor with a short pedicle, respectively. Histologic examination showed that each lesion was typical of IFP of the stomach, with a mixture of fibroblasts and thin-walled blood vessels, and further by an intense infiltrate of eosinophils. These cases indicate that IFP of the stomach can vary in gross appearance. Practitioners and pathologists must remember that not only a polypoid lesion, but also a pedunculated or even ulcerated lesion, in the gastric antrum may be IFP.

A CASE OF LYMPHANGIOMA OF THE DESCENDING COLON

Lymphangioma can occur in every part of the body, but rarely found in the gastrointestinal organs, especially the large intestine. In this paper recent experience with lymphangioma of the descending colon is described with a review of 82 cases seen in the Japanese literature.A 26-year-old man visited the hospital because of abdominal pain and melena. Barium enema study demonstrated an elevated lesion with smooth surface of the descending colon. Colonoscopy revealed a pale yellowish tumor with smooth surface in the descending colon, and the shape of the tumor was easily changed on compression. A diagnosis of submucosal tumor was made and the patient was operated on. The resected specimen revealed a 3.0×2.5 cm sized soft tumor with fluctation, the surface of which was covered with normal smooth mucosa. Microscopically, the tumor was diagnosed as cystic lymphanigoma.In Japan, to our knowledge, 82 cases of lymphangioma of the colon and rectum have been reported since Yoshitoshi and collegues reported the first case. The mean age of the patients was 52.7 years, and the male to female ratio was 5:2. These tumors were found in whole regions of the large intestine, but about 72% of them were located through the cecum to transverse colon. The maximum diameters of the tumors ranged from 0.5-12 cm with an average of 3.1 cm. Twenty-seven cases had the diameter of less than 2 cm. In the treatment, endoscopic polypectomy was employed for the small lymphangiomas less than 2 cm in diameter, while surgical resection for the larger tumors. No malignant potential has been reported. It is important that we should take careful attitude to make the differential diagnosis and minimize surgical invasion.

The Capability of Three Dimensional Display during Endoscopic Ultrasonography

Abstract: Endoscopic ultrasonography (EUS) has been found to be useful in determining the depth of invasion of gastric cancer, the diagnosis of submucosal tumors and extramural compressions. A problem with this procedure is that it is difficult to determine stereoscopically the relative position of the lesion as a whole, even though EUS may be an excellent diagnostic tool for determining tomographies. In this paper, we made three‐dimensional displays of EUS images using a personal computer to facilitate understanding of the relative anatomical positions of the lesions. During EUS examination, the distance from the incisors was acccurately measured, and the EUS image was recorded on U‐matic tape. To measure the distance from the incisors, we devised a new instrument for measuring the endoscopic insertion length. The recorded tape was edited for input into the computer. The soft‐ware for the three‐dimensional display program was made by Photoron. Inc. A patient with esophageal cancer, a patient with a common bile duct stone and a patient with pancreatic cancer are presented as examples for definition of the relationship with the surrounding organs. A patient with a gastric ulcer is used as an example to clarify the pathological structure of the lesions. Using our method on these patients, it was easy to obtain a stereograph and to obtain complete images of the lesions. EUS was available for three ‐dimensional displays of the lesions in the gastrointestinal tract and in the surrounding area, and this has clinical significance.

Use of Endoscopic Ultrasonography for the Diagnosis of Colorectal Tumors

Ultrasonographic evaluation of colorectal diseases has been realized by the development of echocolonoscopes. Endoscopic ultrasonography was performed in 90 cases of colorectal tumor, and the diagnostic yields were assessed; the cases included 72 with cancer, 13 with polyp, and 5 with submucosal tumor. With respect to cancer extent, EUS correctly estimated the depth of cancer invasion in 84.9% of 53 cases in which the lesion was appropriately visualized. Paraintestinal lymph node metastasis was detected in 38.1%. EUS was not so successful in the evaluation of polyps, since the histological types could not be differentiated, nor could the focus of cancer in adenoma be demonstrated. EUS was effective in the differential diagnosis of submucosal tumors, since the ultrasonographic features varied by histological types.

Transbronchial needle aspiration biopsy in the diagnosis of pulmonary neoplasms

To evaluate the usefulness of transbronchial needle aspiration biopsy (TBNAB) in the primary diagnosis of lung cancer, we undertook a prospective study of this technique, assessing specimens from 124 patients over a 3-yr period. Cytologic and/or histologic material obtained by an alternate technique was available for 105 (84.7%) of the patients. The diagnostic sensitivity of TBNAB was comparable with that of other bronchoscopic techniques; with the addition of TBNAB, the overall sensitivity of bronchoscopy was increased from 54% to 72% (P less than 0.001). Because of its usefulness for diagnosis of submucosal tumors and its safety, we conclude that TBNAB is a useful addition to current methods for the diagnosis of suspicious pulmonary lesions.

Endoscopic Ultrasonography in the Diagnosis of Submucosal Tumor of the Upper Digestive Tract

The clinical value of endoscopic ultrasonography (EUS) in the diagnosis of submucosal tumors (SMT) in the upper digestive tract was examined. EUS was performed in 83 patients with SMT or submucosal compressions by extracanal organs or lesions. The 50 cases of SMT and 33 cases of extracanal compression could be diagnosed accurately. All SMT were easily detected, even if they were smaller than 5 mm in diameter. EUS visualized in which of the five layers of the digestive tract wall the submucosal tumor was located and depicted the size of the tumor accurately as confirmed by examination of the resected material. Leiomyoma and leiomyosarcoma originating in the mucosal muscle layer and the proper muscle layer were difficult to distinguish by EUS. The submucosal tumors in the submucosal layer, such as cysts, an aberrant pancreas, fibromas, and lipomas could be diagnosed by the analysis of echogenicity and echo-pattern of the tumor ultrasonograms. EUS was considered to be the most useful method among the conventional body imaging techniques to visualize submucosal tumors.

Diagnosis of submucosal tumor by injecting a water soluble contrast medium: development pattern and growing of tumors.

With the application of our endoscopical method of contrasted X-ray imaging, gastric submucosal tumors were studied with chief regards to their modes of growing up and patterns of development. It has become known that, of extra-gastric developing tumors, larger ones tend to show Pattern IVa and smaller ones Pattern IVb. Generally, the tumors showed a tendency of becoming larger in older patients. Periodical checking disclosed about 15% of the tumors growing larger with the lapse of time. It has been surmised that as tumors grow up, their development possibly turns from intra-gastric to intramural and mingled in pattern. Their modes of growing could be classified as follows: Abruptly growing large at a certain time and then remaining without notable changes, step-by-step enlarging, and gradually growing up straight forwardly with years.

Diagnosis of submucosal tumors by injecting a water soluble contrast medium: judgement of tumor developing pattern and endoscopic lumpectomy.

With the remarkable increases in the number of cases of endoscopical removal of submucosal tumors spurred by the application of high-frequency current, it has become more and more important to apply beforehand some reliable methods like ours to differentiate between tumors and other tumescent lesions due to extra-gastric pressure similar in configuration to tumors and also to confirm the development patterns of tumors either intra-gastric or extra-gastric. Such preparatory arrangements seem indispensable to minimize the risk of perforation incidental to the endoscopical treatment of tumors. To cope with another danger of major bleeding following tumor resection, securing on hand an effective hemostatic is indispensable as well. In our care of the patients after their undergoing endoscopical lumpectomies, we usually subject them to quiet rest and fasting for two or three days; then when they are to resume a regular diet, we endoscopically examine them before and after each meal to confirm the presence or absence of bleeding. In 12 subjects of this series treated with our routine and finally with lumpectomies for gastric submucosal tumors, no serious adverse reactions developed.

Diagnosis of submucosal tumors by injecting a water soluble contrast medium: Basic research and imaging of tumors.

With the aim of adequately distinguishing gastric submucosal tumors from other lesions such as gastric polyps, gastritis, and protuberances due to extragastric pressure, a new method was developed. A water soluble contrast medium is endoscopically injected into a submucosal lesion followed immediately by the application of roentgenography, thereby obtaining X-ray pictures of the lesion through frontal and lateral projections. Since the contrast substance is water soluble, the method can visualize submucosal microchanges. Highly diffusible, the substance usually has a fading time of about 40 min, the present method is convincingly free of danger. This paper provides the results of basic research performed using adult mongrel dogs together with some comments on the applicability of the method in clinical use.