This document discusses polyps and malignancy of the large bowel. It begins by providing anatomy of the colon and rectum. It then discusses various types of colonic polyps including hyperplastic, adenomatous, and polyposis syndromes. Imaging features of polyps on colonoscopy, barium enema, CT, and MRI are presented. Characteristics of different polyposis syndromes such as FAP, Gardner's syndrome, Turcot syndrome, and Peutz-Jeghers syndrome are summarized. The document emphasizes the premalignant potential of adenomatous polyps and importance of recognizing polyposis syndromes.
This document discusses colorectal polyps. It defines polyps and describes their types, including neoplastic and non-neoplastic polyps. It discusses adenomatous polyps in depth, noting their malignant potential increases with size over 1cm and villous architecture. Radiological diagnostic methods for polyps including single and double contrast barium enema and CT colonography are explained. The document provides an overview of polyp pathogenesis and genetic syndromes like FAP that increase cancer risk.
This document provides a workup algorithm for focal liver lesions. It discusses obtaining a patient history and physical exam findings, as well as blood tests, imaging studies, and biopsy. Common benign and malignant liver lesions are described, including their risk factors, imaging characteristics, and treatment options. For example, hemangiomas are the most common benign tumor, often appearing as well-demarcated lesions on ultrasound and MRI. Hepatocellular carcinoma is the most common primary liver cancer and often appears as a vascular enhancing mass on CT scan. Treatment may involve surgery, chemotherapy, or liver transplantation depending on the type and stage of liver lesion.
Gastrointestinal stromal tumors (GISTs) are rare sarcomas that arise from the gastrointestinal tract. Most commonly found in the stomach, they represent 0.2% of gastrointestinal tumors. While often asymptomatic, they can present with bleeding, pain, or obstruction. Diagnosis involves imaging such as endoscopy or CT scan followed by biopsy showing immunohistochemistry positive for CD117 in 95% of cases. Treatment involves surgical resection with clear margins although adjuvant therapy with imatinib is often used for higher risk tumors. Outcomes have improved greatly in the past two decades with 5-year survival rates now over 50% with appropriate treatment.
Cystic liver lesions - An ultrasound perspectiveSamir Haffar
This document summarizes the diagnosis and imaging findings of various cystic hepatic lesions. It describes simple hepatic cysts, hydatid cysts, and congenital fibrocystic liver diseases including biliary hamartomas, peribiliary cysts, choledochal cysts, and polycystic liver disease. Imaging findings on ultrasound, CT, MRI, and MRCP are provided for each condition to aid diagnosis. Differential features between lesion types are emphasized, along with WHO classification of hydatid cyst appearance and post-operative evaluation of hydatid cyst treatment.
The document discusses imaging features of small bowel lymphoma. It begins by outlining the pathogenesis, distribution, and risk factors of small bowel lymphoma. It then describes the clinical features and histopathology. The role of various imaging modalities like CT, MRI, ultrasound, and contrast studies are discussed. Key imaging features include circumferential thickening, aneurysmal dilatation, nodular lesions, and intussusception. Staging is also addressed. Imaging is important for diagnosis, staging, and assessing complications of small bowel lymphoma.
Carcinoid tumors are slow-growing neuroendocrine tumors that commonly arise in the gastrointestinal tract and lungs. The document discusses carcinoid tumors in depth, including their definition, sites of origin, histology, staging, clinical features, diagnostic testing, and management approaches. Treatment involves surgical resection when possible, with additional therapies for advanced or metastatic disease aimed at controlling hormone secretion and tumor growth.
This document discusses colorectal polyps. It defines polyps and describes their types, including neoplastic and non-neoplastic polyps. It discusses adenomatous polyps in depth, noting their malignant potential increases with size over 1cm and villous architecture. Radiological diagnostic methods for polyps including single and double contrast barium enema and CT colonography are explained. The document provides an overview of polyp pathogenesis and genetic syndromes like FAP that increase cancer risk.
This document provides a workup algorithm for focal liver lesions. It discusses obtaining a patient history and physical exam findings, as well as blood tests, imaging studies, and biopsy. Common benign and malignant liver lesions are described, including their risk factors, imaging characteristics, and treatment options. For example, hemangiomas are the most common benign tumor, often appearing as well-demarcated lesions on ultrasound and MRI. Hepatocellular carcinoma is the most common primary liver cancer and often appears as a vascular enhancing mass on CT scan. Treatment may involve surgery, chemotherapy, or liver transplantation depending on the type and stage of liver lesion.
Gastrointestinal stromal tumors (GISTs) are rare sarcomas that arise from the gastrointestinal tract. Most commonly found in the stomach, they represent 0.2% of gastrointestinal tumors. While often asymptomatic, they can present with bleeding, pain, or obstruction. Diagnosis involves imaging such as endoscopy or CT scan followed by biopsy showing immunohistochemistry positive for CD117 in 95% of cases. Treatment involves surgical resection with clear margins although adjuvant therapy with imatinib is often used for higher risk tumors. Outcomes have improved greatly in the past two decades with 5-year survival rates now over 50% with appropriate treatment.
Cystic liver lesions - An ultrasound perspectiveSamir Haffar
This document summarizes the diagnosis and imaging findings of various cystic hepatic lesions. It describes simple hepatic cysts, hydatid cysts, and congenital fibrocystic liver diseases including biliary hamartomas, peribiliary cysts, choledochal cysts, and polycystic liver disease. Imaging findings on ultrasound, CT, MRI, and MRCP are provided for each condition to aid diagnosis. Differential features between lesion types are emphasized, along with WHO classification of hydatid cyst appearance and post-operative evaluation of hydatid cyst treatment.
The document discusses imaging features of small bowel lymphoma. It begins by outlining the pathogenesis, distribution, and risk factors of small bowel lymphoma. It then describes the clinical features and histopathology. The role of various imaging modalities like CT, MRI, ultrasound, and contrast studies are discussed. Key imaging features include circumferential thickening, aneurysmal dilatation, nodular lesions, and intussusception. Staging is also addressed. Imaging is important for diagnosis, staging, and assessing complications of small bowel lymphoma.
Carcinoid tumors are slow-growing neuroendocrine tumors that commonly arise in the gastrointestinal tract and lungs. The document discusses carcinoid tumors in depth, including their definition, sites of origin, histology, staging, clinical features, diagnostic testing, and management approaches. Treatment involves surgical resection when possible, with additional therapies for advanced or metastatic disease aimed at controlling hormone secretion and tumor growth.
This document discusses primary lymphomas of the gastrointestinal tract. It begins by providing background on lymphomas and noting that the gastrointestinal tract is a common extra-nodal site. The most common subtypes of primary GI lymphomas are then described, including their typical locations and risk factors. Diagnostic workup, staging systems, treatments, and outcomes are outlined for several subtypes affecting different areas of the GI tract, such as diffuse large B-cell lymphoma and MALT lymphoma in the stomach, and immunoproliferative small intestinal disease. Throughout, key points are illustrated with images and tables.
Radiology plays an important role in evaluating gastrointestinal lymphoma. Primary gastrointestinal lymphoma arises in the lymphatic tissue of the bowel rather than lymph nodes. Common sites of involvement include the stomach, small bowel, and colon. On imaging, gastrointestinal lymphoma can appear as thickened folds, masses, strictures, or diffuse bowel wall thickening. Staging involves assessing for involvement of lymph nodes, adjacent organs, or distant metastases. Radiology is useful for diagnosis, evaluating extent of disease, and monitoring treatment response in gastrointestinal lymphoma.
This document discusses the evaluation and management of cystic tumors of the pancreas. It notes that the most common types are serous cystadenomas, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Initial imaging includes MRI with MRCP and EUS with FNA to characterize the cyst. Cyst fluid analysis is important to distinguish malignant potential. Small asymptomatic cysts may only need follow up imaging. Surveillance is recommended for certain non-surgical cases, monitoring for changes or malignant progression over multiple years.
This document discusses the approach to evaluating and diagnosing liver masses. It defines a liver mass and explains how imaging techniques are used in the diagnosis. The differential diagnosis for liver masses can range from benign to malignant lesions. Cystic lesions discussed in detail include pyogenic and amoebic liver abscesses. Solid lesions include inflammatory conditions like abscesses as well as benign and malignant tumors. Treatment options for different lesions are outlined.
A 45-year-old female presented with recurrent vomiting, loss of appetite, abdominal pain, and significant weight loss over 6 months. Imaging revealed a 7x5cm cystic lesion in the pancreatic head and neck. The differential diagnosis for cystic pancreatic lesions includes pseudocyst, serous cystadenoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, and rarer entities. Specific imaging features, cyst fluid analysis, and clinical characteristics can help differentiate these potential diagnoses to guide management of the patient's cystic pancreatic lesion.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
This document provides information on gastrointestinal lymphoma, including its classification, staging, and management. It begins with an introduction stating that GI lymphoma is the most common extranodal lymphoma, primarily affecting the stomach. It then discusses the classification systems used for lymphoma and notes that GI lymphoma has its own classification system. The document outlines the Ann Arbor and Lugano staging systems used for GI lymphoma and notes factors unique to staging lymphoma in the GI tract. It concludes with an overview of management approaches for different GI lymphoma subtypes, including chemotherapy regimens, H. pylori testing and treatment, radiation therapy, and surgery.
This document discusses solitary liver lesions, categorizing them as benign tumours, infections, trauma, malignant tumours or other. It provides detailed information about cavernous haemangioma, including that it is the most common benign liver tumour, often appearing as a well-defined hypodense lesion on imaging with characteristic enhancement. Hepatic abscesses and hydatid cysts are also described, noting ultrasound, CT and MRI findings help differentiate bacterial vs parasitic abscesses and stages of cyst growth.
This document discusses different types of intestinal polyps. It begins by defining a polyp as an abnormal growth projecting from a mucous membrane. The main types discussed are epithelial polyps, which include adenomas, serrated lesions like hyperplastic polyps and sessile serrated adenomas/polyps, and hamartomas. Adenomas are further classified based on histology and risk of malignancy. Serrated lesions have distinct histologic features and molecular profiles. Certain polyp types are associated with hereditary cancer syndromes like familial adenomatous polyposis. Accurate classification and reporting of polyps helps determine cancer risk and appropriate surveillance for patients.
This document provides an overview of esophageal cancer, including the two main histologic types (squamous cell carcinoma and adenocarcinoma), routes of tumor spread, imaging features on CT, and the TNM staging system. Key points include:
- Esophageal cancer most commonly presents as squamous cell carcinoma or adenocarcinoma. Adenocarcinoma has a better prognosis and is more commonly found in the distal esophagus.
- The cancer can spread locally via direct extension or lymphatically. Distant metastases most often involve the liver, lungs, bones and other sites.
- CT is useful for staging by evaluating wall thickness, lymph nodes, and invasion of nearby structures.
This document discusses different types of esophageal strictures seen on imaging. It provides details on the typical locations and appearances of peptic, Barrett's esophagus, malignant, caustic, radiation, and other strictures. Examples of double-contrast esophagograms are shown to illustrate the features of peptic, Schatzki's ring, malignant, nasogastric intubation, Barrett's esophagus, radiation, caustic, and other strictures. The document concludes by presenting cases where observers judged strictures as benign, malignant, or equivocal based on imaging findings which were then correlated with endoscopy results.
This document discusses the embryology and anatomy of the stomach. It provides the following key points:
1. During embryonic development, the stomach rotates along its longitudinal and anteroposterior axes, causing its final adult position with the cardiac portion on the left and pylorus on the right.
2. The adult stomach is located in the left upper quadrant and extends across the midline, with the greater curvature forming the anterior wall and lesser curvature the posterior wall.
3. Radiological techniques for examining the stomach include barium studies, CT, MRI, and virtual endoscopy, which allow evaluation of stomach morphology, layers, and relationships to surrounding organs.
This document discusses various diseases and abnormalities that can affect the liver as seen on medical imaging. It provides definitions and radiographic features of diffuse liver diseases including hepatitis, cirrhosis, fatty liver, focal confluent fibrosis, glycogen storage disease, Gaucher's disease, and hemochromatosis. It also discusses infections of the liver such as viral hepatitis, bacterial abscesses, fungal diseases, and parasitic diseases including amebic abscesses, hydatid disease, and bilharziasis. For each condition, it outlines the definition, classification, and characteristic imaging appearance on ultrasound and CT scans.
This document discusses tumors of the appendix. It outlines different types of appendix tumors including mucocele, primary adenocarcinoma, cystadenocarcinoma, and carcinoid tumors. Mucocele occurs when the appendix lumen becomes blocked, causing a fluid-filled cyst. Ruptured mucocele or adenocarcinoma can lead to pseudomyxoma peritonei, where mucus accumulates in the abdominal cavity. Carcinoid tumors are the most common appendix tumors but are generally not aggressive. Management depends on tumor type but often involves surgical removal of the appendix or part of the colon.
This document provides an overview of intestinal polyps. It begins with an introduction and relevant anatomy. Polyps are then classified based on size, attachment, and cellular architecture. Both non-neoplastic and neoplastic polyps are discussed. Non-neoplastic polyps include hyperplastic, juvenile, Peutz-Jeghers, inflammatory, Cronkhite-Canada, and Cowden polyps. Neoplastic polyps include adenomatous and syndromic polyps associated with Familial Adenomatous Polyposis (FAP) and Hereditary Nonpolyposis Colon Cancer (HNPCC). The pathogenesis and molecular biology of adenomatous polyps is also reviewed. Management strategies
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
The document discusses imaging features of small bowel lesions. It describes the normal anatomy of the small bowel and different types of abnormal fold patterns seen with disease. Type I folds are described as thin (<3 mm), straight folds with dilated lumen. Causes of Type I folds include mechanical obstruction, paralytic ileus, scleroderma, and sprue. Mechanical obstruction leads to dilated proximal loops with a transition point. Scleroderma causes luminal dilatation and a "hidebound bowel" appearance. Celiac disease results in fluid excess, dilution of contrast, and sometimes reversal of the normal jejunal-ileal fold pattern.
This document discusses benign focal liver lesions of different cellular origins - hepatocellular, cholangiocellular, and mesenchymal. It provides details on common benign liver tumors including cavernous hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, hepatic cysts, and infantile hemangioendothelioma. Imaging characteristics on ultrasound, CT, and MRI scans are described to help differentiate these benign liver lesions. Common features seen include hypodense lesions on CT, varying signal intensities on MRI, presence of fat, cystic components, enhancement patterns, and visualization of scars.
The document provides information on hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It discusses the life cycle of the parasite, symptoms, investigations including imaging techniques, classification of cysts, treatment options including surgery, percutaneous drainage (PAIR procedure), and chemotherapy. PAIR involves puncturing the cyst, injecting a scolicidal agent, and reaspirating the contents to treat the cyst minimally invasively.
Fluoroscopic imaging anatomy and pathology of stomach and duodenum abdul finalabduljelil nejmu
FLUOROSCOPIC IMAGING ANATOMY AND PATHOLOGY OF STOMACH AND DUODENUM
This document outlines the anatomy of the stomach and duodenum as seen on barium imaging studies. It describes the normal appearance and divisions of the stomach. Common pathologies are discussed, including gastric cancers, lymphomas, ulcers and polyps. Early gastric cancers appear as polyps or shallow ulcers while advanced cancers cause thickening or narrowing. Lymphomas manifest as thickened folds, masses or ulcers. Polyps are categorized as hyperplastic, adenomatous or villous. H. pylori infection is a common cause of thickened gastric folds and erosions. The
This document discusses imaging of salivary gland pathologies. It begins with the anatomy of major and minor salivary glands. Common pathologies include sialolithiasis, acute and chronic sialadenitis, ranula, and various neoplasms. Imaging modalities like ultrasound, CT, MRI, and radionuclide studies are used to evaluate the glands. Ultrasound can identify stones, duct dilatation, and blood flow. CT and MRI accurately depict glandular anatomy and pathology. Sialography and MR sialography help in evaluating obstructive diseases. Both benign and malignant neoplasms can involve the salivary glands.
This document discusses primary lymphomas of the gastrointestinal tract. It begins by providing background on lymphomas and noting that the gastrointestinal tract is a common extra-nodal site. The most common subtypes of primary GI lymphomas are then described, including their typical locations and risk factors. Diagnostic workup, staging systems, treatments, and outcomes are outlined for several subtypes affecting different areas of the GI tract, such as diffuse large B-cell lymphoma and MALT lymphoma in the stomach, and immunoproliferative small intestinal disease. Throughout, key points are illustrated with images and tables.
Radiology plays an important role in evaluating gastrointestinal lymphoma. Primary gastrointestinal lymphoma arises in the lymphatic tissue of the bowel rather than lymph nodes. Common sites of involvement include the stomach, small bowel, and colon. On imaging, gastrointestinal lymphoma can appear as thickened folds, masses, strictures, or diffuse bowel wall thickening. Staging involves assessing for involvement of lymph nodes, adjacent organs, or distant metastases. Radiology is useful for diagnosis, evaluating extent of disease, and monitoring treatment response in gastrointestinal lymphoma.
This document discusses the evaluation and management of cystic tumors of the pancreas. It notes that the most common types are serous cystadenomas, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Initial imaging includes MRI with MRCP and EUS with FNA to characterize the cyst. Cyst fluid analysis is important to distinguish malignant potential. Small asymptomatic cysts may only need follow up imaging. Surveillance is recommended for certain non-surgical cases, monitoring for changes or malignant progression over multiple years.
This document discusses the approach to evaluating and diagnosing liver masses. It defines a liver mass and explains how imaging techniques are used in the diagnosis. The differential diagnosis for liver masses can range from benign to malignant lesions. Cystic lesions discussed in detail include pyogenic and amoebic liver abscesses. Solid lesions include inflammatory conditions like abscesses as well as benign and malignant tumors. Treatment options for different lesions are outlined.
A 45-year-old female presented with recurrent vomiting, loss of appetite, abdominal pain, and significant weight loss over 6 months. Imaging revealed a 7x5cm cystic lesion in the pancreatic head and neck. The differential diagnosis for cystic pancreatic lesions includes pseudocyst, serous cystadenoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, and rarer entities. Specific imaging features, cyst fluid analysis, and clinical characteristics can help differentiate these potential diagnoses to guide management of the patient's cystic pancreatic lesion.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
This document provides information on gastrointestinal lymphoma, including its classification, staging, and management. It begins with an introduction stating that GI lymphoma is the most common extranodal lymphoma, primarily affecting the stomach. It then discusses the classification systems used for lymphoma and notes that GI lymphoma has its own classification system. The document outlines the Ann Arbor and Lugano staging systems used for GI lymphoma and notes factors unique to staging lymphoma in the GI tract. It concludes with an overview of management approaches for different GI lymphoma subtypes, including chemotherapy regimens, H. pylori testing and treatment, radiation therapy, and surgery.
This document discusses solitary liver lesions, categorizing them as benign tumours, infections, trauma, malignant tumours or other. It provides detailed information about cavernous haemangioma, including that it is the most common benign liver tumour, often appearing as a well-defined hypodense lesion on imaging with characteristic enhancement. Hepatic abscesses and hydatid cysts are also described, noting ultrasound, CT and MRI findings help differentiate bacterial vs parasitic abscesses and stages of cyst growth.
This document discusses different types of intestinal polyps. It begins by defining a polyp as an abnormal growth projecting from a mucous membrane. The main types discussed are epithelial polyps, which include adenomas, serrated lesions like hyperplastic polyps and sessile serrated adenomas/polyps, and hamartomas. Adenomas are further classified based on histology and risk of malignancy. Serrated lesions have distinct histologic features and molecular profiles. Certain polyp types are associated with hereditary cancer syndromes like familial adenomatous polyposis. Accurate classification and reporting of polyps helps determine cancer risk and appropriate surveillance for patients.
This document provides an overview of esophageal cancer, including the two main histologic types (squamous cell carcinoma and adenocarcinoma), routes of tumor spread, imaging features on CT, and the TNM staging system. Key points include:
- Esophageal cancer most commonly presents as squamous cell carcinoma or adenocarcinoma. Adenocarcinoma has a better prognosis and is more commonly found in the distal esophagus.
- The cancer can spread locally via direct extension or lymphatically. Distant metastases most often involve the liver, lungs, bones and other sites.
- CT is useful for staging by evaluating wall thickness, lymph nodes, and invasion of nearby structures.
This document discusses different types of esophageal strictures seen on imaging. It provides details on the typical locations and appearances of peptic, Barrett's esophagus, malignant, caustic, radiation, and other strictures. Examples of double-contrast esophagograms are shown to illustrate the features of peptic, Schatzki's ring, malignant, nasogastric intubation, Barrett's esophagus, radiation, caustic, and other strictures. The document concludes by presenting cases where observers judged strictures as benign, malignant, or equivocal based on imaging findings which were then correlated with endoscopy results.
This document discusses the embryology and anatomy of the stomach. It provides the following key points:
1. During embryonic development, the stomach rotates along its longitudinal and anteroposterior axes, causing its final adult position with the cardiac portion on the left and pylorus on the right.
2. The adult stomach is located in the left upper quadrant and extends across the midline, with the greater curvature forming the anterior wall and lesser curvature the posterior wall.
3. Radiological techniques for examining the stomach include barium studies, CT, MRI, and virtual endoscopy, which allow evaluation of stomach morphology, layers, and relationships to surrounding organs.
This document discusses various diseases and abnormalities that can affect the liver as seen on medical imaging. It provides definitions and radiographic features of diffuse liver diseases including hepatitis, cirrhosis, fatty liver, focal confluent fibrosis, glycogen storage disease, Gaucher's disease, and hemochromatosis. It also discusses infections of the liver such as viral hepatitis, bacterial abscesses, fungal diseases, and parasitic diseases including amebic abscesses, hydatid disease, and bilharziasis. For each condition, it outlines the definition, classification, and characteristic imaging appearance on ultrasound and CT scans.
This document discusses tumors of the appendix. It outlines different types of appendix tumors including mucocele, primary adenocarcinoma, cystadenocarcinoma, and carcinoid tumors. Mucocele occurs when the appendix lumen becomes blocked, causing a fluid-filled cyst. Ruptured mucocele or adenocarcinoma can lead to pseudomyxoma peritonei, where mucus accumulates in the abdominal cavity. Carcinoid tumors are the most common appendix tumors but are generally not aggressive. Management depends on tumor type but often involves surgical removal of the appendix or part of the colon.
This document provides an overview of intestinal polyps. It begins with an introduction and relevant anatomy. Polyps are then classified based on size, attachment, and cellular architecture. Both non-neoplastic and neoplastic polyps are discussed. Non-neoplastic polyps include hyperplastic, juvenile, Peutz-Jeghers, inflammatory, Cronkhite-Canada, and Cowden polyps. Neoplastic polyps include adenomatous and syndromic polyps associated with Familial Adenomatous Polyposis (FAP) and Hereditary Nonpolyposis Colon Cancer (HNPCC). The pathogenesis and molecular biology of adenomatous polyps is also reviewed. Management strategies
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
The document discusses imaging features of small bowel lesions. It describes the normal anatomy of the small bowel and different types of abnormal fold patterns seen with disease. Type I folds are described as thin (<3 mm), straight folds with dilated lumen. Causes of Type I folds include mechanical obstruction, paralytic ileus, scleroderma, and sprue. Mechanical obstruction leads to dilated proximal loops with a transition point. Scleroderma causes luminal dilatation and a "hidebound bowel" appearance. Celiac disease results in fluid excess, dilution of contrast, and sometimes reversal of the normal jejunal-ileal fold pattern.
This document discusses benign focal liver lesions of different cellular origins - hepatocellular, cholangiocellular, and mesenchymal. It provides details on common benign liver tumors including cavernous hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, hepatic cysts, and infantile hemangioendothelioma. Imaging characteristics on ultrasound, CT, and MRI scans are described to help differentiate these benign liver lesions. Common features seen include hypodense lesions on CT, varying signal intensities on MRI, presence of fat, cystic components, enhancement patterns, and visualization of scars.
The document provides information on hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It discusses the life cycle of the parasite, symptoms, investigations including imaging techniques, classification of cysts, treatment options including surgery, percutaneous drainage (PAIR procedure), and chemotherapy. PAIR involves puncturing the cyst, injecting a scolicidal agent, and reaspirating the contents to treat the cyst minimally invasively.
Fluoroscopic imaging anatomy and pathology of stomach and duodenum abdul finalabduljelil nejmu
FLUOROSCOPIC IMAGING ANATOMY AND PATHOLOGY OF STOMACH AND DUODENUM
This document outlines the anatomy of the stomach and duodenum as seen on barium imaging studies. It describes the normal appearance and divisions of the stomach. Common pathologies are discussed, including gastric cancers, lymphomas, ulcers and polyps. Early gastric cancers appear as polyps or shallow ulcers while advanced cancers cause thickening or narrowing. Lymphomas manifest as thickened folds, masses or ulcers. Polyps are categorized as hyperplastic, adenomatous or villous. H. pylori infection is a common cause of thickened gastric folds and erosions. The
This document discusses imaging of salivary gland pathologies. It begins with the anatomy of major and minor salivary glands. Common pathologies include sialolithiasis, acute and chronic sialadenitis, ranula, and various neoplasms. Imaging modalities like ultrasound, CT, MRI, and radionuclide studies are used to evaluate the glands. Ultrasound can identify stones, duct dilatation, and blood flow. CT and MRI accurately depict glandular anatomy and pathology. Sialography and MR sialography help in evaluating obstructive diseases. Both benign and malignant neoplasms can involve the salivary glands.
This document discusses colorectal polyps and carcinomas, including definitions, classifications, diagnoses, and characterizations. It describes the pathological classifications of neoplastic and non-neoplastic polyps. Neoplastic polyps include adenomas, carcinomas, and submucosal tumors. Adenomas can be characterized by their histopathology, endoscopic appearance, and associations with polyposis syndromes. Serrated adenomas and familial adenomatous polyposis are also summarized. The document outlines hereditary non-polypoid colorectal cancer and submucosal tumors of the colon.
1) Familial adenomatous polyposis (FAP) is an autosomal dominant condition characterized by the development of hundreds to thousands of colonic polyps.
2) It is caused by a mutation in the APC gene and results in nearly 100% risk of colon cancer if left untreated.
3) Treatment involves prophylactic colectomy with either ileorectal anastomosis or restorative proctocolectomy with ileal pouch-anal anastomosis to remove the pre-cancerous colonic mucosa.
This document provides an overview of gallbladder and bile duct anatomy, ultrasound techniques, and common abnormalities. It discusses the anatomy of the gallbladder and bile ducts. Key points include the normal sonographic appearance of the gallbladder and distinguishing features of various gallbladder abnormalities like stones, polyps, and wall thickening. It also reviews bile duct anatomy and variants, ultrasound technique, and pathologies that can cause bile duct dilation or wall thickening such as stones, cancer, and cystic diseases. Evaluation of both the gallbladder and bile ducts is important using ultrasound.
Serrated Pathway to colorectal carcinomaIpsita Panda
This document discusses the serrated pathway to colorectal cancer, which accounts for approximately 40% of colon cancers. It outlines the histological classification of serrated lesions such as hyperplastic polyps, sessile serrated adenomas/polyps, and traditional serrated adenomas. Serrated lesions are associated with a distinct molecular pathway to colorectal cancer characterized by BRAF mutations rather than APC mutations seen in the conventional adenoma-carcinoma sequence. Management and surveillance guidelines differ for patients with serrated lesions due to their proximal location in the colon and potential for aggressive cancer.
Salivary gland imaging radiology ppt . This powerpoint presentation includes important anatomy and important pathology of salivary gland with its imaging feature as well as its ct mri image. This will help alot. this will help for radiology resident as well as ent .
This document provides an overview of large intestinal tumors, including the anatomy and normal histology of the intestine, classification of tumors, and descriptions of various polyps, cancers, and other tumor types. Key points covered include the normal histology of the colon and rectum, WHO classification of colon and rectal tumors, descriptions of adenomas, hyperplastic polyps, hamartomatous polyps, familial adenomatous polyposis, colorectal carcinoma, pathogenesis, clinical features, morphology, microscopy, immunohistochemistry, staging systems for colorectal cancer.
Primary neoplasms of the small bowel are uncommon, accounting for only 1-5% of gastrointestinal neoplasms. Over 40 histologic types of both benign and malignant tumors have been identified in the small bowel. The most common benign neoplasms are adenomas, gastrointestinal stromal tumors (GISTs), lipomas, and hemangiomas. Malignant neoplasms include adenocarcinoma, carcinoid tumors, malignant GISTs, lymphomas, and metastases from other sites. Imaging with CT enterography, CT enteroclysis, MR enterography, or small bowel follow through can help identify and characterize small bowel neoplasms.
Gastrointestinal polyps can be classified based on their morphology and location. Inflammatory polyps are a type of benign polyp caused by inflammation in the gastrointestinal tract. They are usually asymptomatic but can sometimes cause bleeding. Microscopically, inflammatory polyps show features of inflammation, ulceration, and regeneration in the lamina propria. Hamartomatous polyps like juvenile polyps and Peutz-Jeghers polyps are genetic conditions characterized by the overgrowth of normal tissues. Juvenile polyps can occasionally harbor dysplasia and patients with juvenile polyposis have an increased cancer risk, requiring endoscopic surveillance.
Neoplastic polyps can be benign or malignant. Adenomas are benign epithelial tumors that have the potential to become cancerous over time. There are several types of adenomas classified by their histological features, including tubular, villous, and tubulovillous. Large or villous adenomas have a higher risk of already containing cancer. Removal of adenomas is important as nearly all colon cancers develop from these polyps. Risk factors for the adenoma containing high-grade dysplasia or cancer include large size over 1 cm, villous histology, presence of high-grade dysplasia, and having multiple polyps.
The gallbladder is located in a fossa on the inferior surface of the liver. It has three parts - the fundus, body, and neck. Gallbladder cancer is usually adenocarcinoma and spreads early through direct extension into nearby organs and lymphatic invasion. Risk factors include gallstones and anomalous pancreaticobiliary junction. Ultrasound, CT, MRI, and PET scans are used for diagnosis but often the cancer is only discovered during cholecystectomy for other reasons. Surgical resection is the main treatment if the cancer is localized but prognosis is poor due to frequent late stage at diagnosis from non-specific symptoms.
The document discusses colorectal cancer (CRC), including risk factors, symptoms, diagnostic procedures, staging classifications, and treatment options. Key points include: CRC risk is increased by factors like age, family history, and inflammatory bowel diseases. Symptoms depend on tumor location but may include bleeding, pain, and changes in bowel habits. Diagnostic workup involves colonoscopy, biopsy, and imaging tests. Staging uses the TNM system and determines five-year survival rates. Treatment involves surgery like colectomy or polypectomy and postoperative monitoring for recurrence.
Colonic adenomas are benign epithelial tumors that can develop into colorectal cancer over time. They range in size and can be pedunculated or sessile. Microscopically, they are characterized by epithelial dysplasia and nuclear abnormalities. Certain familial polyposis syndromes, like familial adenomatous polyposis and Lynch syndrome, are associated with an increased risk of developing numerous colonic adenomas and colorectal cancer at a young age due to genetic mutations. Surveillance colonoscopy is recommended to screen for and remove adenomas to prevent cancer.
A 30-year-old female presented with a one month history of left iliac fossa pain, anorexia, weight loss, and vomiting for one week. Examination revealed a tender palpable mass in the left iliac fossa. CT scan showed sigmoid colon cancer with liver metastases. At laparotomy, a perforated sigmoid colon mass was found adhered to surrounding structures with pus collection. A sigmoid colectomy with end colostomy was performed.
Radiodiagnosis of salivary gland tumoursPankaj Kaira
The document discusses salivary gland tumors and their radiological evaluation. It describes the major and minor salivary glands and their drainage pathways. Common benign tumors include pleomorphic adenoma, which appears as a well-defined, lobulated, heterogeneous mass on imaging. Malignant tumors include mucoepidermoid carcinoma and adenoid cystic carcinoma. Imaging modalities like ultrasound, sialography, CT, MRI and PET are used to identify, characterize and stage salivary gland tumors.
This document provides information on tumors of the salivary glands. It discusses the anatomy and histology of salivary glands, classification of salivary gland tumors, and specifics on certain tumor types including pleomorphic adenoma and Warthin's tumor. Pleomorphic adenoma is the most common benign salivary gland tumor, characterized by epithelial and mesenchymal differentiation. Warthin's tumor commonly occurs bilaterally in the parotid glands of older smoking males. The document covers epidemiology, etiology, histogenesis, clinical features, investigation, pathology and treatment of various salivary gland tumors.
1. The document discusses various white matter disorders that can be seen on MRI imaging. It focuses on demyelinating diseases like multiple sclerosis (MS), neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), and other related conditions.
2. MS is characterized by well-defined white matter lesions that are often ovoid or perpendicular to the ventricles. Lesions can also be seen in the corpus callosum, brainstem, spinal cord, and optic nerves. MRI is important for diagnosis and monitoring of MS.
3. NMO preferentially affects the spinal cord and optic nerves. Lesions are often longitudinally extensive in the spinal
This document provides an overview of echocardiography, including the basics of trans-thoracic echocardiography, normal doppler echocardiography, and evaluation of cardiac chambers and structures. It discusses the standard scanning planes used in echocardiography including parasternal, apical, subcostal, and suprasternal. It also covers doppler modalities for assessing blood flow through structures like the valves and vessels. The implications of echocardiography are evaluating cardiac size, function, valves, hemodynamics, and diseases.
This document provides an overview of common congenital skeletal anomalies seen from the head to the toes. It begins with definitions of craniosynostosis and discusses specific types. Other anomalies of the skull discussed include lacunar skull. Common anomalies of the orbits, mandible, scapula, clavicles, pelvis and long bones are then summarized. Specific bone anomalies including clubfoot, vertebral anomalies, and skeletal dysplasias such as osteopetrosis are also briefly described. Radiographic appearances of many of these conditions are illustrated with examples.
This document provides an overview of imaging modalities used to evaluate ovarian tumors. It discusses the epidemiology, relevant anatomy, and types of ovarian tumors seen on ultrasound, CT, MRI, and PET/CT. The major epithelial tumors described are serous cystadenocarcinoma, mucinous cystadenocarcinoma, endometrioid carcinoma, and clear cell carcinoma. It also reviews sex cord-stromal tumors, germ cell tumors including teratomas and dysgerminoma, and the patterns of ovarian cancer spread. Imaging findings for each tumor type are presented to aid in differential diagnosis.
Normal anatomy and congenital anomalies of vena cavaeGobardhan Thapa
This document discusses the normal anatomy and common congenital anomalies of the superior and inferior vena cavae. It begins with an overview of the embryological development of the vena cavae. It then describes the normal anatomy of the superior and inferior vena cavae and their major tributaries. Common congenital anomalies are then outlined, including double superior vena cavae, left-sided superior vena cava, left inferior vena cava, double inferior vena cava, azygos continuation of the inferior vena cava, and circumcaval anomalies of the left renal vein and ureter. Clinical significance is discussed for some anomalies.
This document provides an overview of MRI techniques for evaluating the shoulder joint and common shoulder pathologies. It begins with normal shoulder anatomy as seen on MRI and descriptions of impingement syndrome, rotator cuff tears, labral tears, instability, biceps tendon injuries, and other conditions. For each pathology, the document describes MRI appearance and features that should be included in reports. In summary, the document is a guide for radiologists to understand MRI of the shoulder and identify and characterize various shoulder injuries and diseases.
This document outlines an approach to evaluating mediastinal pathology using radiological imaging. It begins with definitions of the mediastinum and schemes for dividing it anatomically. It then describes how to approach lesions based on their location in the anterior, middle, or posterior mediastinum. Common pathologies are discussed for each division, including lymphadenopathy, thymomas, cysts, and vascular lesions. Radiological investigations like chest x-rays, CT, MRI, and biopsies are outlined. Specific conditions such as retrosternal goiters, germ cell tumors, lipomatosis, and hernias are also summarized.
1) MDCT provides detailed images of coronary artery anatomy and is useful for evaluating common coronary pathologies.
2) The coronary arteries normally arise from the sinuses of Valsalva and have variable branching patterns. MDCT helps distinguish benign variants from potentially dangerous anomalies.
3) Coronary artery anomalies can involve abnormal origins, courses, or terminations and in some cases may lead to ischemia or sudden cardiac death. MDCT is well-suited to characterize these anomalies.
This document discusses imaging of malignant lesions of the uterus. It begins by reviewing carcinoma of the cervix, noting that MRI is excellent for defining local tumor extent and metastatic spread. It then discusses endometrial carcinoma, the most common gynecological malignancy in developed countries. Imaging findings on ultrasound, CT, and MRI are presented for staging endometrial carcinoma, from Stage I confined to the uterus to Stage IV with distant metastasis. Other rare malignant lesions of the uterus mentioned include endometrial stromal sarcoma and leiomyosarcoma.
This document discusses the normal development of the brain from embryology through childhood. It covers topics like dorsal induction, ventral induction, neuronal proliferation and migration, common congenital brain lesions seen on imaging like holoprosencephaly, arachnoid cysts, corpus callosum agenesis, and porencephaly. Imaging findings for many of these conditions are also described. The document provides a comprehensive overview of brain development and common congenital abnormalities.
This document discusses various fungal infections of the chest and their imaging appearances. It provides an overview of 9 main fungal organisms (Histoplasmosis, Coccidioidomycosis, Blastomycosis, Paracoccidioidomycosis, Candidiasis, Pneumocystis, Cryptococcosis, Mucormycosis, Aspergillosis) and summarizes their typical radiographic or CT findings. These include calcified nodules, cavitating lesions, consolidations, ground glass opacities, and halo signs which help differentiate the fungal pathogens.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
2. ANATOMY OF COLON
• Length - 120 to 200 cm.
• Extraperitoneal – AC, DC, rectum
• Intraperitoneal- cecum, TC, sigmoid
• Transverse and sigmoid colon– mesentery (mesocolon)–
more mobility.
• Distinguishing feature — 3 taenia coli -- haustral
sacculations.
3. Rectum
– Rectosigmoid junction at Third sacral
segment
– Sigmoid mesocolon ends - Rectum begins
– 15-18 cm long
– No haustra
– Two or three full thickness folds – valves of
Houston.
5. Lymphatic drainage of colon
• Lymph from large intestine passes from
four sets of lymph nodes
– Epicolic LN on the wall of the colon
– Paracolic LN on the medial side of AC and DC
and near the mesocolic border of sigmoid and
TC.
– Intermediate LN on the main branches of the
vessels
– Terminal nodes on the SMA and IMA.
6. Landmarks and measurements related to colon
• S3 segment- rectosigmoid junction
• Presacral space 0.7 to 1.5 cm
• Maximum diameter of cecum – 9 cm and
transverse colon – 5.5 cm
• Colon wall thickness
– With distension by oral contrast
• 3 mm or less normal
• 4 to 6 mm s/o pathology
• > 6mm definitely abnormal
– With distension by per rectal air
• 3mm upper limit for rectum
• 2mm upper limit for colon
7. COLONIC POLYPS
• Localized mass that
projects from the mucosa
into the lumen.
• Pathologically mucosal
overgrowth.
• Subdivisions traditionally:
– Hyperplastic(harmless)
– Adenomatous(premalignant)
– Others: juvenile,
inflammatory, lymphoid other
rare polyps
9. IMAGING OF POLYPS:
• Fibreoptic Colonoscopy
– Highest detection rate for polyps
even those < 1 cm in size.
– Biopsy and polypectomy at the
same sitting possible.
– Disadvantage:
• Cost
• High perforation rate than Ba enema
(1 in 1700)
• Failure to reach the cecum in 5-30%
of cases.
10. • Double contrast Ba enema (DCBE)
• Filling defects on dependent
surface
• Etched in white when on
nondependent surface
• Small non-pedunculated polyps-
Bowler Hat sign when seen on
oblique view.
• Pedunculated polyps - target or
Mexican hat sign on end on
view.
• Has to be differentiated from
diverticula, feces, flexural
pseudotumors and other pitfalls.
Fig. Bowler hat sign
Fig. pedunculated polyp
11. • Double contrast Ba enema( contd)
– Frequently impossible to say benign or malignant. Size and
morphology may help.
Size Histology Risk of
Malignancy
<5mm Almost all hyperplastic 0.5%
5-10 mm 90%adenoma 1%
10-20 mm Usually adenomas 10%
>20 mm Usually adenomas 50%
•Morphology- can’t reliably predict histology. But in case of villous
adenoma typical fronds or cauliflower like appearance will be
there.
12. Features which favor the polyp is most
likely malignant
1. Large size >2cm
2. Irregular lobulated surface (frond-like
surface)
3. Base wider than height
4. Base retracted.
5. sessile
Size alone is the best predictor of malignancy radiologically.
13. CT Scan
–Not used for dx
–Help to depict any malignant
transformation and complications
(perforation, fistula, mets in liver
and adjacent structures)
–Polyps are seen as intraluminal
filling defects.
14. CT COLONOGRAPHY
– Rapidly emerging alternative to invasive
fibreoptic colonoscopy.
– Pre-requisites:
• Cleansed bowel
• optimal bowel distension with air or CO2
• use of MDCT,
• prone and supine imaging in single breath
hold (for each position),
• 1.25 to 2.5mm collimation and
reconstruction interval of 1mm,
• software programmes that provide
endoluminal display and “fly through”
capabilities provide 3D volume rendering
image processing.
• both 2D axial CT reconstructions and 3D
volume-rendered image.
Fig. Surface reconstruction of
images can identify the colonic
wall in a manner that appears like
optical endoscopy of the colon.
The triangular appearance is
characteristic of folds in the
transverse colon; hence, some
practitioners term these methods
virtual colonoscopy
15. Fig. (A) Endoluminal CTC image depicting a polyp (arrow) growing on a
haustral fold just above residual colonic fluid (B) corresponding 2D image
shows a stalked lesion (arrow) coated by a thin rim of tagged fluid.
16. Fig. (A) 3D CT colonogram – polypoid lesion simulating a sessile polyp. (B)
2D view shows a tiny locule of gas (arrow) demonstrating that this is a
retained fecal residue.
• Fecal residue – may mimic a polyp
- has variable attenuation due to internal gas content
unlike homogeneous soft tissue attenuation of a polyp
- fecal tagging using oral contrast
17. • MRI
– Not a primary modality for polyps
– show polyp signal intensity
comparable to that of bowel on
non-enhanced images. After
gadolinium, enhancement is
similar to that of bowel on early
and late images.
• MR colonoscopy
– Studies have shown that MR-
based endoluminal assessment
of colon is possible.
Fig. sagittal image post
contrast FS MR colonogram –
an enhancing sigmoid polpyp
(arrow)
18. • Ultrasound
–Insensitive for polyp scanning due to
bowel gas.
–May be used to assess polyps and
mass after retrograde instillation of
warm sodium chloride solution into
the colon – polyp appear as
hyperechoic structures projecting into
the lumen.
–Can be used to screen thyroid, abd,
breast etc in polyposis syndrome
cases/relatives.
19. HYPERPLASTIC POLYPS
• 90% Colonic polyps (autopsy)
• 20% surgically removed polyps
• Recto-sigmoid common site. May occur
anywhere.
• Any age group. Diagnosed most commonly at 50-
70 yrs.
• Size – 90% < 0.5cm 10% > 0.5cm
• Larger polyps - rarely develop adenomatous foci
(serrated adenoma)
• Significance - No malignant potential except in
rare instances.
21. Tubular Tubulo-villous Villous
Incidence Most common (75%) - Least common
Site Anywhere in colon 1.Distal colon and
rectum(75%) 2. Cecum
n AC
Propensity for
Rectosigmoid
Morphology Pedunculated or
sessile
Mixed pattern broad based, sessile,
cauliflower-like(frond-like)
surface, Large,
Malignant
potential
Least among 3. Depends upon degree
of villous component.
Greatest malignant
potential
Symptoms Asymptomatic mostly.
Rectal bleeding
Asymptomatic to rectal
bleeding.
Symptomatic more often than
other 2.
Rectal bleeding.
Electrolyte imbalance d/t
hypersecretion—hypokalemia
and profuse mucus
discharge.
22. Polyposis syndrome
• Multiple polyps within gi tract.
• Types
– Familial inherited (autosomal dominant)
– Nonfamilial
24. • Non-inherited polyposis syndrome
– Cronkhite-Canada syndrome
• Polyps with nail atrophy, brownish skin
pigmentation and alopecia.
• Watery diarrhea and protein losing enteropathy.
25. • Syndrome recognition important as the
adenomatous polyposis is premalignant.
• Should be considered when-
–Intestinal polyp in young patient
–2 or more polyps in any patient
–Colonic Ca in < 40 yrs of age
–Related extra-intestinal manifestations.
26. Familial adenomatous polyposis coli
• AD inheritance
• Mutation in APC gene
(chromosome 5q21).
• 2/3rd
of ptt– family h/o FAP
or colonic Ca
• 1/3rd
of ptt– disease occurs
as spontaneous mutation
• All affected family members
exhibit polyps by the age of
35 yrs.
27. FAP coli( contd.)
• 1-2mm to 1cm to larger
polyps—150 to over 1000;
carpeting the colon
• Mostly diffuse
involvement, occasionally
segmental.
• Associations
– Hamartomatous polyps in
stomach(49%)
– Adenomatous polyps of
duodenum(25%) and
– Periampullary carcinoma
Fig. FAP syndrome. Colonic mucosa
carpeted with innumerable small
polyps seen as tiny filling defects.
28. FAP coli (contd.)
• Malignant potential
– All pt develop colonic Ca by 20 yrs of dx.
• Attenuated adenomatous polyposis
syndrome – variant of AFP; fewer
polyps(<100, as few as 5-10 polyps).
29. GARDNER SYNDROME
• Variant of FAP with prominent skeletal and
skin manifestations.
• FAP and Gardner syndrome may occur in
the same family.
• Polyps - histologically adenomatous as in
FAP.
• 100% pt – malignant transformation.
31. Osseous abnormalities – exostosis, bone
islands.
Endocrine tumours – papillary Ca thyroid,
Carcinoid tumor of small bowel, parathyroid
adenoma
CNS - medulloblastoma
Abnormal dentition – supernumary teeth,
impacted teeth
32. • Desmoplastic tendency of fibrous
tissues in pt with Gardner syndrome
results in
– Desmoid tumours
– Keloids
– Mesenteric fibrosis and Peritoneal adhesions
– Retroperitoneal fibrosis and
– Mammary fibromatosis
33. TURCOT SYNDROME
• Turcot syndrome is an association between
colonic polyps (adenomatous), colonic
carcinoma and brain tumors.
• Most brain tumours are supra-tentorial
glioblastoma; occasionally medulloblastoma.
• Other reported abnormalities
– Sebaceous cysts
– Papillary Ca of thyroid
– Leukemia and
– Spinal cord tumours
34. TURCOT SYNDROME(contd.)
• Mutations in two types of genes:
– Mutation in APC gene– mostly a/w brain tumors.
Recent study- APC gene mutation and FAP ptt 90 x
more risk of developing brain tumours than general
populations.
– Mutation of 1 of 2 mismatch repair genes, hMLH1 and
hPMS2--- higher risk of developing Ca. This mutation
also cause hereditary non-polyposis colorectal cancer
(HNPCC or LYNCH SYNDROME).
35. Peutz-Jeghers syndrome
• Multiple hamartomatous intestinal
polyps associated with
mucocutaneous melanotic
pigmentation.
• Mutations of STK11 gene (location
19p).
• Polyps occur mainly in the
stomach and small bowel; large
bowel polyps are fewer, but are
larger often pedunculated, and
may bleed.
36. • GI polyps
– Small bowel-------- 95% ptt—may carpet it.
– Stomach and du– 25% ptt
– Colon n rectum---- 25% ptt – no carpeting
usually.
• Non-GI polyps
– Nose, larynx, bronchial tree
– Urinary tract (particularly UB)
Peutz-Jeghers syndrome(contd.)
37. • Malignant change rare. Risk of developing
other neoplasm 18 times > general pop.
• Variety of malignant tumours associated:
– In 13 % cases pancreatic Ca
– Breast Ca (mainly ductal) commonly B/L
– Ovarian cyst and neoplasms in 5% cases.
– Neoplasms in thyroid, lung, skin, uterus and
testicles has also been reported.
Peutz-Jeghers syndrome(contd.)
38. JUVENILE POLYPOSIS SYNDROME
• Most common cause of colonic polyposis in
children - rare.
• 3 forms
– Familial juvenile polyposis of stomach
– Familial ,, ,, coli- rectosigmoid
common.
– Generelised ,, ,, - polyps through out GI tract.
• Variable penetrance of the disease, variable no.
of polyps.
• Polyps invariably possess stalk.
39. Screening and surveillance of patient with
adenomatous polyposis coli syndrome
• First degree relative with FAP:
– Flexible sigmoidoscopy
– Start at puberty(10-12 yrs) or sooner in
symptomatic patient.
– Do annually until adenomas detected or until
genetic testing done along with index patient
or until found not to have mutant gene that
caused the disease in index patient.
– After 25 yrs if no polyps, do every 2 yrs till the
age of 35 yr by when almost all exhibit polyps.
40. Colonic malignancy
• Primary Adenocarcinoma - almost 99%
of colorectal carcinoma.
• Mucinous Adenocarcinoma
• Primary signet ring cell carcinoma (linitis
plastica)
• Metastatic tumours
• GISTs
• Lymphoma
41. Colonic adenocarcinoma
• 3rd
most common Ca in
men and women in
North America and
West Europe.
• Most common GI Ca
• Best prognosis. 5 yr
survival rate of ~50%
can be improved by
screening -
polypectomy.
42. • Origin
– Majority adenoma-carcinoma sequence from adenomatous polyps
and polyposis.
– Some from non-polypoid dysplastic mucosa as in inflammatory
bowel disease.
• Polyp dwell time
– Initiated polyp grow for 10-15 yrs before becoming frankly
malignant.
43. • Distribution of adenomatous polyps and
cancer
Site Polyp % Cancer %
rectosigmoid 52 55
DC 18 6
TC 11 11
AC 13 9
Cecum 7 13
44. RISKS FOR COLONIC CARCINOMA
– High fat low fiber diet
– Age >50 yrs
– Personal h/o colorectal adenomatous polyps
– First degree relative with colorectal Ca (3-fold risk).
– Adenomatous polyposis coli ( FAP, Gardner S, Turcot
S) - 100% risk if no colectomy.
– Juvenile polyposis syndrome, PJS: slightly increased
risk.
– Inflammatory bowel disease
• UC( risk 30% after 25 yrs)
• CD( 4-to 10-fold risk).
46. – mutation of mismatch repair (MMR) genes
– Life time risk of CRC is 70-85%; occur at
earlier age (mean 45 years) - More common
in rt side
“Amsterdam” criteria {3-2-1 rule}:
– colorectal cancer in at least 3 family members
spanning 2 generations, with at least 1 case
diagnosed before the age of 50 yrs.
Lynch syndrome (HNPCC)
47. • Preferred examinations
– Digital rectal examination
– Stool inspection and occult blood test
– CBC, LFT, CEA level.
– Sigmoidoscopy or colonoscopy
– DCBE study
– CT scan and CTC
– MRI and MRC
Imaging Adenocarcinoma Colon
48. • DCBE
– Gold standard to see mucosal
detail
– Early carcinoma looks like
polypoidal mass.
– Advanced Ca gives one or more of
the 3 morphological appearances
• Polypoid lesions - contour deformity
along one margin of bowel wall/ filling
defect.
• Annular lesions - apple-core lesions
(narrow lumen, mucosal irregularity
and overhanging edges - shouldering)
• Flat lesions are rare.
49. Annular carcinoma sigmoid colon-
circumferential mass causing lumen
narrowing & mucosal destruction
and the overhanging edges or
shouldering at the tumor margins
Apple core lesion in ascending colon
Apple core sigmoid cancer
51. Conventional CT:
–Area of focal wall
thickening (>3 mm),
usually homogeneous
but can be
heterogeneous in large
adenoCa or mucinous
tumors or when
associated with abscess
formation.
Fig. Cecal carcinoma with
circumferential involvement of
the cecal wall.
52. – CT has higher sensitivity and lower specificity than
MRI in T staging.
– Overall T, N and M staging accuracy are comparable
to both CT and MRI.( 60%, 60%, 90% for TNM
respectively)
For staging and to assess recurrence.
Goal is to predict 3 factors which affect prognosis
Depth of tumour penetration in colon wall
Regional or distant lymph node mets
Distant mets to other sites.
53. Enlarged portal nodes (between
inferior vena cava and portal
vein) & hepatic metastases Recurrent colon Ca invades sacrum
54. • CT Colonography and
MR Colonography
– Can be used to
diagnose the colonic
ca.
– Sensitivity and
specificity is higher for
advanced cases. For
small polypoidal
lesions role and
limitations are as
described previously.
Fig. Colon Ca – CT colonography
55. Fig. 2D axial CT colonogram image –
circumferential tumor (arrow)
Fig. sagittal oblique CT through
mid-sigmoid cancer showing an
irregular outer margin extending
into pericolic fat
56. • Ultrasound
– To detect hepatic mets (70-90 %
detection rate).
– Most hepatic mets are hyperechoic;
may be hypoechoic also.
– Tumour itself looks as a target sign
(hyperechoic centre surrounded by
echopoor mass) or as a localised
irregular colonic wall thickening, an
irregular contour , lack of normal
peristalsis and absence of normal
layered appearance of colonic wall.
– Endorectal US: for local invasion by
tumour. Competes with MRI to
detect local tumour invasion.
Fig. USG cecal
carcinoma-- concentric
thickening of the
hypoechoic bowel wall
by the tumor
57. Radionuclide study
–May be used to detect tumour
recurrence
• Radioimmunoscintigraphy with monoclonal
antibody that recognises CEA or tumour
associated glycoprotein-72 to detect
recurrence in pelvis and extrahepatic
abdomen.
• PET with fluorodeoxyglucose (FDG)
58. Role of intervention in Ca colon
• Stent placement across the obstructing Ca
– To improve general condition of the ptt before surgery
– In ptt unfit for surgery or in unresectable tumours– as
a palliative measure.
• Intra-arterial chemotherapy for unresectable
tumours
• Intra-arterial chemotherapy via hepatic artery for
hepatic mets from colon Ca.
• Radiofrequency thermal ablation in selected
patient with hepatic mets from colon Ca.
59. Colon, adenocarcinoma-
STAGING
• Modified Dukes staging
Stage Description
A Limited to mucosa
B
B1
B2
Involvement of muscularis propria
Extension into mp
Extension through mp into serosa/mesenteric fat.
C
C1
C2
Lymph node metastasis
+ growth limited to bowel wall
+growth extending into adipose tissue
D Distant mets
60. TNM staging (7th
edition)
•T
• Tis - carcinoma in situ
• T1 - invasion of submucosa
• T2 - invasion of muscularis propria
• T3 - invasion outside muscularis
propria
• T4 - T4a invasion of visceral
peritoneum, T4b invasion of
other organs
•N
• N0 - no lymph node involvement
• N1 - 1 to 3 pericolic lymph node
involvement
• N2 - >/= 4 pericolic LN involvement
•M
• M0 - no distant mets
• M1 - distant mets M1a in one organ
M1b in > 1 organ or peritoneum
Fig. layers involved in T1 – T4
colorectal cancers according to the
TNM, 7th
edition
61. • TNM staging (contd.)
Stage Grouping 5-yr survival
0 TisN0M0 >95%
I T1N0M0
T2N0M0 75 to 100%
II T3N0M0
T4N0M0 50 to 75 %
III AnyT N1 M0
AnyT N2,3M0 30 to 50%
IV anyT anyN M1 < 10%
62. Other large bowel tumors
• Carcinoid tumors
• Mostly in cecum, rectum and appendix.
• May result in carcinoid syndrome.
• Non-specific imaging findings.
63. Primary appendiceal adenoCa:
•Rare, 0.5% of all neoplasms of GIT.
•Found in <2% of appendectomy
specimens.
•Cystic and colonic growth pattern
64. • Cystic type: mucin
producing –
tendency to rupture
and spread
throughout peritoneal
cavity –
pseudomyxoma
peritonei.
• Colonic type:
develop from tubular
and tubulovillous
adenoma, similar to
Fig. primary appendiceal
adenocarcinoma
65. • Colonic lymphoma
• Usually arises from nodal disease, rarely primary (0.5%).
• Lymphoid tissue mostly in cecum and rectum – majority
lymphoma site.
• B cell Hodgkin type
• Bulky polypoid lesions to diffuse annular infiltrating
forms.
66. • Mucosa intact: sub-mucosal spread and lumen patent
• CT: bulky soft tissue mass
Fig. axial CT – marked symmetrical bowel wall thickening (arrows)
secondary to primary colonic lymphoma. Note the lumen remains patent.
67. Metastatic disease to colon:
• Intra-peritoneal seedling:
–Ovarian, gastric, pancreatic
• Hematogeneous routes:
–Malignant melanoma, breast, lung
•Multiple bizarre, extrinsic lesions
•Particular site eg POD
68. • Contiguous spread:
–From prostate, bladder or ovary
• Spread along the mesentery:
–Pancreatic Ca to transverse
mesocolon
69. Summary
• Colonoscopy best method by sensitivity, specificity and
due to added adv of Bx and polypectomy. But has disadv
of invasiveness and occasional failure to reach cecum.
• DCBE - gold standard imaging modality to see mucosal
detail. high detection rate for >1cm polyps but low for <
1cm ones.
• CT and MRI - for staging
• CTC and MRC – emerging alternative for invasive
fibreoptic colonoscopy. Till date has not replaced it.
• USG - To detect mets in liver.
• TRUS - competes with MRI to accurately find out the
local invasion of Ca rectum.
71. References
• Text book of Radiology and Imaging,
David Sutton; 7/e.
• Fundamentals of diagnostic radiology,
Bryant and Helms; 4/e.
• Grainger and Allison’s diagnostic
radiology, 6/e.
Editor's Notes
2nd Image shows a large polyp in the cecum on a stalk. Histologically, the polyp was hamartomatous.
Factors affecting s and s: Bowel cleansing, Optimal bowel distension, Optimal amount of Ba
Adv over fibreoptic colonoscopy
Noninvasive- good ptt compliance, Chance of perforation eliminated
Whole colon can be imaged.
Disadv over FOC
Sensitivity lower
Radiation to ptt
For high quality MDCT required.
MRI has higher sensitivity( 91% vs 82%) and specificity ( 100% vs 69%) than CT to detect local reccurence.
False +ve/-ve findings are low. May occur due to diverticulitis, crohn disease, tuberculous colitis.