Somatostatinomas

Somatostatinomas are the rarest of the neuroendocrine tumors, presenting with signs of inhibition of other endocrine hormone production. The syndrome consists of diabetes melli-tus, gallbladder disease (cholelithiasis), weight loss, anemia, diarrhea, and steatorrhea, all felt to be owing to the inhibitory effects of somatostatin. The most common primary site is the pancreas followed closely by the duodenum. Somatostatinomas can occur in MEN-1 and in patients with neurofibromatosis (20). The...

Gastrinoma and the Zollinger Ellison Syndrome ZES

Gastrinomas produce the ZES, named by the surgeons who described the clinical disorder resulting from excessive gastric acid production. The tumor should be suspected after recognition of the constellation of clinical symptoms that include ulcer-like abdominal pain (dyspepsia) with associated diarrhea. The endo-scopic findings of peptic ulcer disease and concomitant esophagi-tis are a clue to the diagnosis. Profound acid hypersecretion leads to ulcerations throughout the upper gut, and the...

Small Bowel And Colonic Lymphomas

About 10 of all GI tract lymphomas arise in the small intestine. The incidence of small bowel lymphoma peaks in the seventh decade of life and there is slight male predominance. Most tumors arise in the distal small bowel, most likely because there is more lymphoid tissue in these areas, especially in the terminal ileum. Patients often present with abdominal pain, weight loss, anorexia, and less commonly, GI bleeding or iron deficiency anemia (50). Small bowel lymphomas can be divided into the...

Systemic Chemotherapy

In order to understand the current literature in the neoadju-vant and adjuvant settings, a review of chemotherapy agents in the metastatic disease will be discussed. As with many cancers, gastric cancer was thought to be relatively insensitive to chemotherapy. Most agents used in gastric cancer did not induce a complete response, responses in general were poor, and time to progression was short. Table 1 shows a list of singleagent drugs with activity in gastric cancer. The standard first-line...

Benign Tumors

Benign gastric tumors can either be mucosal or submucosal in origin. Mucosa lesions consist primarily of hyperplastic and adenomatous polyps, whereas submucosal lesions include GI stromal tumors, lipomas, and ectopic pancreatic rests. Fig. 14. Early adenocarcinoma in Barrett's esophagus. Double-contrast esophagram shows a relatively long peptic stricture in the distal esophagus with slight flattening and stiffening of one wall of the stricture (arrows) owing to pathologically proven carcinoma...

Clinical Presentation

Small tumors that present owing to symptoms of hormone excess might be diagnosed at an early and potentially surgically Insulinoma Insulinoma syndrome Gastrinoma Zollinger-Ellison syndrome Glucagonoma Glucagonoma syndrome VIPoma Verner-Morrison, pancreatic cholera Headaches, visual disturbances, irrational behavior, confusion, drowsiness Abdominal pain, peptic ulcer disease, diarrhea, reflux esophagitis Necrolytic migratory erythema, diabetes, weight loss Secretory diarrhea > 1 L d,...

References

Tumors of the esophagus and stomach. In Ming SC, ed. Atlas of Tumor Pathology, Fascicle 7. Washington, DC Armed Forces Institute of Pathology 1973 16-23. 2. Sandvik AK, Aase S, Kveberg KH, Dalen A, Folvik M, Naess O. Papillomatosis of the esophagus. J Clin Gastroenterol 1996 22 35-37. 3. Montesi A, Pesaresi A, Graziani L, Salmistraro D, Dini L, Beazi I. Small benign tumors of the esophagus radiological diagnosis with double-contrast examination. Gastrointest Radiol 1983 8 207-212. 4....

B

Liver metastases confirmed by positron emission tomography imaging. (A) Axial computed tomography (CT) image through dome of liver shows a 9-mm low attenuation lesion in the lateral segment of the left lobe. A smaller, 7-mm nodule was seen in the liver tip. (B) Positron emission tomography image demonstrates uptake of 5-fluorodeoxyglucose in the lesion in the lateral segment of the liver lobe (arrow) and at the liver tip, corresponding to the tiny lesions detected at CT, findings...

Celiac Plexus Neurolysis

The majority of pancreatic cancer patients have pain (68,69), therefore pain control and quality of life are of paramount importance in this unfortunate group of patients with limited life expectancy. Opioid administration is frequently necessary, however side effects such as constipation, nausea, vomiting, and drowsiness may limit dosing and effect. CPN, where the celiac plexus is ablated with a neurolytic agent, has additionally been offered to pancreatic cancer patients for pain control....

Other Colonic Tumors

LIPOMAS AND OTHER BENIGN LESIONS Colonic lipomas are encapsulated masses of mature fat cells, predominately arising in the submucosa. Most lipomas (70 ) are found in the cecum and ascending colon. Multiple lipomas are found in 25 of patients (53). Radiographically, these tumors appear as smooth-surfaced pedunculated, semi-pedunculated, or sessile masses that change size and shape with compression and varying degrees of colonic distension (54,55) (Fig. 22). These tumors are not infrequently...

Plastic Stents

Bioabsorbable Pancreatic Stent

In 1980, Soehendra and Reynders-Frederix described for the first time the endoscopic insertion of a 7-French (F) biliary stent to restore biliary flow in a distal CBD tumor (19). For many years plastic stents had been the only available devices and today they still represent a valid therapeutic option (Fig. 1A). The most common configuration is a straight or curved stent with side flaps at each end to minimize the risk of proximal or distal migration, which may still occur up to 9 of patients...

Gastritis

Probably no term in gastroenterology is so widely misused as gastritis. As an endoscopic finding it may be used to indicate redness of the mucosa, or whiteness, mucosal lesions, erosions or red dots, and the state of the stomach when yellow fluid is present. In this chapter, gastritis refers to the histological state, Multifocal atrophic gastritis Atrophic gastritis of body and environmental or genetic factors Autoimmune inflammation of antrum with intestinal metaplasia Chronic active Normal...

Dysplasia

Gastric dysplasia is most often found in indistinguishable sites. In other words, the dysplastic mucosa is endoscopically no different from the surrounding mucosa. Dysplasia, manifest as an adenomatous polyp, is uncommon in the stomach. In a study of 1900 cases of early gastric cancer from Japan, 95 arose in an epithelial change within atrophic gastritis and only 3 within an adenomatous polyp (5). Most gastric polyps are non-neoplastic, the most common are hyperplastic or fundic gland. Gastric...

Photodynamic Therapy

PDT Indications and Contraindications PDT is a nonthermal ablative technique resulting in local necrosis of malignant esophageal tissue. PDT is indicated for the palliative management of malignant esophageal strictures and ablation of Barrett's esophagus with high-grade dysplasia in non-surgical candidates. In this chapter, the focus is solely on palliation of malignant dysphagia. When considering PDT for palliation, most esophageal cancer patients have either failed, refused, or are...

Gastric Lymphomas

The stomach is the most common site for GI lymphoma to occur, accounting for 75 of all GI lymphomas and 10 of lymphomas overall (10). Only 3 of gastric cancers are lymphomas. The clinical features of a patient with gastric lymphoma vary but include epigastric pain, dyspepsia, anorexia, weight loss, nausea, emesis, and early satiety. Physical exam is usual normal, but a palpable abdominal mass or peripheral lymphadenopathy may be present. Most gastric lymphomas are extranodal marginal zone...

Epidemiology

The true incidence of GISTs is unknown. The lack of epi-demiological data may be in part owing to the variable classification and definition of GISTs in the past. Recent estimates of the annual incidence in the United States have been calculated to be as high as 5000-6000 cases per year (3). A large US population-based study of 1458 cases of GISTs identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results registries revealed that the age-adjusted yearly...

Combined Modality Treatment

The rationale for a multiple modality treatment approach to HGD in BE or early adenocarcinoma lies in the ability of EMR to target only macroscopically abnormal areas of mucosa providing effective treatment, but leaving a background of at risk mucosa. This correlates to the significant number of metachronous lesions seen in series in which EMR has been the sole modality of treatment. Mucosal ablative techniques, such as PDT or ABPC complement EMR, by targeting not only the residual dysplastic...

Investigational Methods In Development

Laser-scanning confocal microscopy LCM is a novel optical method that may be able to provide a microscopic image of mucosal surfaces. A special LCM instrument and a probe-type endomicroscope that can be passed through the working channel of an endoscope have been developed for LCM. They scan the mucosa using an argon laser beam with a wavelength of 488 nm and analyze the reflected light. An objective lens with a magnification of x40 is mounted on the LCM instrument. Two studies have shown that...

Info

An inherent disadvantage of high-frequency probes is a limited depth of penetration. Studies evaluating high-frequency ultrasound have shown that accuracy decreases as the size of the tumor increases and these probes should be reserved for tumors less than 2 cm in size. Okumura et al. 31 reported that the accuracy of a 20 MHz was 85.7 for lesions less than 20 mm but that this accuracy fell to 50 for lesions greater than 20 mm. Attenuation of the ultrasound by gastric folds or protruding lesions...

Fecal Occult Blood Tests 321 Guaiac Based Stool Tests

The American College of Physicians has published comprehensive guidelines for fecal occult blood testing FOBT and interpretation with review of the data 7,8 . FOBT has been estimated to detect around 90 of cancers with repeated testing over several years 9 . However, a one-time FOBT three samples has an estimated sensitivity for advanced neo-plasia of only 23.9 10 . FOBT is most commonly performed using a guaiac-based test for peroxidase activity. Therefore, it is important that patients avoid...

Serous Cystadenomas

Cystadenomas

Serous cystadenomas previously known as glycogen-rich cystadenomas are benign, solitary, cystic tumors that arise from centro-acinar cells Fig. 1 . Although the majority of serous cystadenomas are microcystic, there are two other variants based on growth pattern macrocystic and solid. Micro-cystic serous cystadenomas are made up of multiple small thin-walled cysts with a honeycomb-like appearance on cross-section. Microcystic serous cystadenomas may grow to a large diameter over the long-term...

Adenocarcinoma

Although the incidence of gastric carcinoma has declined during the past 50 yr, it continues to be a deadly disease, with overall 5-yr survival rates of less than 20 54 . There also has been a gradual shift in the distribution of gastric cancer from the antrum proximally to the fundus and cardia 55 . As a result, 30-40 of all gastric cancers are located in the fundus or cardiac region 55 . The gastric cardia and fundus therefore should be carefully evaluated in all patients with suspected...

Eus In The Followup Of Anal Cancer

The treatment strategy of anal cancer was changed in the early to mid-1980s when several authors reported excellent T Primary anal cancer Description Fig. 8. A Endoscopic appearance of anal cancer, biopsies confirm squamous cell carcinoma. B,C Rectal endoscopic ultrasound confirms that this is T2N1 stage, with involvement of the internal anal sphinter U , and disruption of the external anal sphinter anteriorly and a single round, hypoechoic, malignant-appearing perirectal lymph node anal cancer...

Morphology

Transverse Colon Radiograph

The most common form of adenocarcinoma is the annular or semiannular lesion, accounting for about one-half of colon carcinomas 25 . Annular cancers are the end-stage of polypoid lesions that have spread circumferentially around the lumen of the bowel. This morphological type is usually found in the transverse, descending, and sigmoid colon. The annular narrowing is often asymmetric, thicker at the site of the original polypoid tumor 27 . The mucosal surface is nodular or ulcerated Fig. 7 . The...

Diagnostic Methods

CT is an excellent test for cystic lesions of the pancreas because of its widespread availability and ability to detect cysts 22 Fig. 3 . MRI is used increasingly because of the lack of radiation exposure and the ability to image the pancreatic duct with MR cholangiopancreatography 23 . Transabdominal ultrasonography may aid in differentiating between solid and cystic lesions, but complete evaluation of the pancreas is often difficult owing to overlying bowel gas. Although seen in less than 20...

Metastases Involving Colon

Tumors can secondarily involve the colon in a variety of ways direct invasion by contiguous tumor either primary or recurrence , spread via a mesentery, intraperitoneal metastases, or hematogenous metastasis 59 . A wide variety of organs about the colon as it courses through the peritoneal space and retroperitoneum. Carcinomas of the gallbladder invade the superior border of the hepatic flexure. Carcinomas of the left kidney or recurrences of left kidney cancer invade the medial border of the...