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01-04-2009 | Gastrointestinal

Role of EUS and MDCT in the diagnosis of gastric submucosal tumors according to the revised pathologic concept of gastrointestinal stromal tumors

Authors: Jung-Ho Kang, Joon Seok Lim, Jie-Hyun Kim, Woo Jin Hyung, Yong Eun Chung, Jin-Young Choi, Mi-Suk Park, Myeong-Jin Kim, Ki Whang Kim

Published in: European Radiology | Issue 4/2009

Abstract

Gastric submucosal tumors (SMTs) consist of various lesions arising from the deep layers of the stomach. Gastrointestinal stromal tumors (GISTs) are undoubtedly the commonest malignant SMTs of the stomach, and therefore the attitude towards the general diagnostic approach for GISTs defines the extended diagnostic plan for SMTs. Two recent consensus meetings were assembled concerning the classification and therapeutic plans for GISTs. These meetings shed light upon the need for the modification of the current role of imaging modalities, including endoscopic ultrasound (EUS) and computed tomography (CT). According to the revised concepts of GISTs, the most important and plausible current role of imaging for the diagnostic approach of gastric SMTs is to differentiate GISTs from other gastric SMTs. This review discusses the newly established diagnostic role of radiology according to the revised classification of GISTs and provides the differential diagnoses based on EUS and CT findings.

Polkowski M (2005) Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endoscopy 37:635–645PubMedCrossRef

Polkowski M, Butruk E (2005) Submucosal lesions. Gastrointest Endosc Clin N Am 15:33–54, viiiPubMedCrossRef

Yoshikane H, Tsukamoto Y, Niwa Y et al (1993) Carcinoid tumors of the gastrointestinal tract: evaluation with endoscopic ultrasonography. Gastrointest Endosc 39:375–383PubMedCrossRef

Chak A (2002) EUS in submucosal tumors. Gastrointest Endosc 56:S43–S48PubMedCrossRef

Lee MJ, Lim JS, Kwon JE et al (2007) Gastric true leiomyoma: computed tomographic findings and pathological correlation. J Comput Assist Tomogr 31:204–208PubMedCrossRef

Burkill GJ, Badran M, Al-Muderis O et al (2003) Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 226:527–532PubMedCrossRef

Kim JK, Won JH, Cho YK, Kim MW, Joo HJ, Suh JH (2001) Glomus tumor of the stomach: CT findings. Abdom Imaging 26:303–305PubMedCrossRef

Park SH, Han JK, Kim TK et al (1999) Unusual gastric tumors: radiologic-pathologic correlation. Radiographics 19:1435–1446PubMed

Fletcher CD, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465PubMedCrossRef

10.

Blay JY, Bonvalot S, Casali P et al (2005) Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 16:566–578

11.

Lee EY, Kim TD, Oh HA (2005) Is the invasive approach for all the upper gastrointestinal mesenchymal tumors necessary? Korean J Gastroenterol 45:387–393PubMed

12.

Nishida T, Hirota S (2000) Biological and clinical review of stromal tumors in the gastrointestinal tract. Histol Histopathol 15:1293–1301PubMed

13.

Aibe T, Fuji T, Okita K, Takemoto T (1986) A fundamental study of normal layer structure of the gastrointestinal wall visualized by endoscopic ultrasonography. Scand J Gastroenterol Suppl 123:6–15PubMedCrossRef

14.

Wiech T, Walch A, Werner M (2005) Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy 37:630–634PubMedCrossRef

15.

Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 23:283–304PubMedCrossRef

16.

Bader TR, Semelka RC, Chiu VC, Armao DM, Woosley JT (2001) MRI of carcinoid tumors: spectrum of appearances in the gastrointestinal tract and liver. J Magn Reson Imaging 14:261–269PubMedCrossRef

17.

Park SH, Han JK, Choi BI et al (2000) Heterotopic pancreas of the stomach: CT findings correlated with pathologic findings in six patients. Abdom Imaging 25:119–123PubMedCrossRef

18.

Horton KM, Juluru K, Montogomery E, Fishman EK (2004) Computed tomography imaging of gastrointestinal stromal tumors with pathology correlation. J Comput Assist Tomogr 28:811–817PubMedCrossRef

19.

McLeod AJ, Zornoza J, Shirkhoda A (1984) Leiomyosarcoma: computed tomographic findings. Radiology 152:133–136PubMed

20.

Pannu HK, Hruban RH, Fishman EK (1999) CT of gastric leiomyosarcoma: patterns of involvement. AJR Am J Roentgenol 173:369–373PubMed

21.

Okai T, Minamoto T, Ohtsubo K et al (2003) Endosonographic evaluation of c-kit-positive gastrointestinal stromal tumor. Abdom Imaging 28:301–307PubMedCrossRef

22.

Levy AD, Quiles AM, Miettinen M, Sobin LH (2005) Gastrointestinal schwannomas: CT features with clinicopathologic correlation. AJR Am J Roentgenol 184:797–802PubMed

23.

Hwang JH, Kimmey MB (2004) The incidental upper gastrointestinal subepithelial mass. Gastroenterology 126:301–307PubMedCrossRef

24.

Hunt GC, Rader AE, Faigel DO (2003) A comparison of EUS features between CD-117 positive GI stromal tumors and CD-117 negative GI spindle cell tumors. Gastrointest Endosc 57:469–474PubMedCrossRef

25.

Ando N, Goto H, Niwa Y et al (2002) The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc 55:37–43PubMedCrossRef

26.

Kawamoto K, Yamada Y, Utsunomiya T et al (1997) Gastrointestinal submucosal tumors: evaluation with endoscopic US. Radiology 205:733–740PubMed

27.

Boyce GA, Sivak MV Jr., Rosch T et al (1991) Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound. Gastrointest Endosc 37:449–454PubMedCrossRef

28.

Matsushita M, Hajiro K, Okazaki K, Takakuwa H (1999) Gastric aberrant pancreas: EUS analysis in comparison with the histology. Gastrointest Endosc 49:493–497PubMedCrossRef

29.

Kim HC, Lee JM, Kim KW et al (2004) Gastrointestinal stromal tumors of the stomach: CT findings and prediction of malignancy. AJR Am J Roentgenol 183:893–898PubMed

30.

Zak Y, Biagini B, Moore H, Desantis M, Ghosh BC (2006) Submucosal resection of giant gastric lipoma. J Surg Oncol 94:63–67PubMedCrossRef

31.

Brand B, Oesterhelweg L, Binmoeller KF et al (2002) Impact of endoscopic ultrasound for evaluation of submucosal lesions in gastrointestinal tract. Dig Liver Dis 34:290–297PubMedCrossRef

32.

Greenson JK (2003) Gastrointestinal stromal tumors and other mesenchymal lesions of the gut. Mod Pathol 16:366–375PubMedCrossRef

33.

Cho JS, Shin KS, Kwon ST et al (2000) Heterotopic pancreas in the stomach: CT findings. Radiology 217:139–144PubMed

34.

Buscarini E, Stasi MD, Rossi S et al (1999) Endosonographic diagnosis of submucosal upper gastrointestinal tract lesions and large fold gastropathies by catheter ultrasound probe. Gastrointest Endosc 49:184–191PubMedCrossRef

35.

Kajiyama T, Hajiro K, Sakai M et al (1996) Endoscopic resection of gastrointestinal submucosal lesions: a comparison between strip biopsy and aspiration lumpectomy. Gastrointest Endosc 44:404–410PubMedCrossRef

36.

Song SY, Noh JH, Lee SJ, Son HJ (2005) Bronchogenic cyst of the stomach masquerading as benign stromal tumor. Pathol Int 55:87–91PubMedCrossRef

37.

McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, Matsumoto S (2000) Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology 217:441–446PubMed

38.

Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD (2005) Current status of gastrointestinal carcinoids. Gastroenterology 128:1717–1751PubMedCrossRef

39.

Levy AD, Sobin LH (2007) From the archives of the AFIP: Gastrointestinal carcinoids: imaging features with clinicopathologic comparison. Radiographics 27:237–257PubMedCrossRef

40.

Ishikawa N, Fuchigami T, Kikuchi Y et al (2000) EUS for gastric lymphangioma. Gastrointest Endosc 52:798–800PubMedCrossRef

41.

Hizawa K, Aoyagi K, Kurahara K et al (1996) Gastrointestinal lymphangioma: endosonographic demonstration and endoscopic removal. Gastrointest Endosc 43:620–624PubMedCrossRef

42.

Tsai CY, Wang HP, Yu SC, Shun CT, Wang TH, Lin JT (1997) Endoscopic ultrasonographic diagnosis of gastric lymphangioma. J Clin Ultrasound 25:333–335PubMedCrossRef

43.

Zhu H, Wu ZY, Lin XZ, Shi B, Upadhyaya M, Chen K (2008) Gastrointestinal tract lymphangiomas: findings at CT and endoscopic imaging with histopathologic correlation. Abdom Imaging. doi:10.1007/s00261-007-9354-6

44.

Demetri GD, von Mehren M, Blanke CD et al (2002) Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347:472–480PubMedCrossRef

45.

van Oosterom AT, Judson I, Verweij J et al (2001) Safety and efficacy of imatinib (STI571) in metastatic gastrointestinal stromal tumours: a phase I study. Lancet 358:1421–1423PubMedCrossRef

46.

Antoch G, Kanja J, Bauer S et al (2004) Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumors. J Nucl Med 45:357–365PubMed

47.

Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3:655–664PubMedCrossRef

48.

Hong X, Choi H, Loyer EM, Benjamin RS, Trent JC, Charnsangavej C (2006) Gastrointestinal stromal tumor: role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. Radiographics 26:481–495PubMedCrossRef

Title: Role of EUS and MDCT in the diagnosis of gastric submucosal tumors according to the revised pathologic concept of gastrointestinal stromal tumors
Authors: Jung-Ho Kang
Joon Seok Lim
Jie-Hyun Kim
Woo Jin Hyung
Yong Eun Chung
Jin-Young Choi
Mi-Suk Park
Myeong-Jin Kim
Ki Whang Kim
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 4/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1224-2

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Role of EUS and MDCT in the diagnosis of gastric submucosal tumors according to the revised pathologic concept of gastrointestinal stromal tumors

Abstract

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Abstract

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