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Evaluation par imagerie médicale des Tumeurs Non Epithéliales du tube digestif

Imaging modalities for evaluation of Non Epithelial Tumors of the upper GI tract

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Acta Endoscopica

Résumé

Lestumeurs non épithéliales du tractus digestif prennent naissance au niveau de l'une des cinq couches histologiques de la paroi digestive. Ces tumeurs peuvent être bénignes ou malignes et résultent d'une prolifération auto-limitée ou plus ou moins bien limitée de cellules qui sont habituellement présentes ou non présentes dans l'un des constituants de la paroi digestive: lymphocytes, plasmocytes, cellules entérochromaffines, fibroblastes, myoblastes, cellules nerveuses, vasculaires ou de l'endothélium lymphatique, adipocytes…

La plupart des tumeurs bénignes sous-muqueuses sont découvertes de façon fortuite. Elles sont le plus souvent de petites tailles, asymptomatiques et sans risque de dégénérescence. Toutefois, les lésions plus volumineuses ou ulcérées peuvent causer des symptômes et dégénérer. Pour leurs évaluations, plusieurs techniques d'imagerie sont disponibles.

L'étude barytée est particulièrement utile pour diagnostiquer ces lésions car la muqueuse qui les recouvre est le plus souvent normale. La prise en charge rationnelle des tumeurs sous-muqueuses bénignes ou malignes dépend essentiellement de l'endoscopie et des prélèvements biopsiques profonds. Un traitement définitif peut être parfois réalisé par endoscopie pour les lésions bénignes. Une grande variété d'autres méthodes d'imagerie peut être utile pour élucider la nature d'une lésion et pour évaluer son bilan d'extension. L'écho-endoscopie associée ou non à l'aspiration à l'aiguille fine est l'extension logique de l'endoscopie pour l'évaluation de ces tumeurs profondes sous-muqueuses et pour déterminer de façon précise la localisation de la lésion qui prend naissance au niveau de l'une des cinq couches de la paroi digestive. LaTDM et laRMN sont particulièrement performantes pour démontrer l'extension et les phénomènes invasifs de la masse et pour révéler les métastases à distance.

Conclusion: L'évaluation de ces lésions est possible grâce à de multiples modalités d'imagerie médicale et est indispensable afin de caractériser leur nature anatomo-pathologique: caractère bénin, potentiellement malin ou franchement malin. Un bilan préthérapeutique correct est également important afin d'orienter au mieux le patient vers l'option thérapeutique la plus appropriée telle que simple surveillance, exérèse endoscopique ou chirurgicale, radiothérapie ou chimiothérapie.

Summary

Non-epithelial tumors of the GI tract arise from one of the five layers of the digestive wall. These tumors can be benign or malignant and result from a self or more or less limited proliferation of cells which are usually present or not inside one of the constituents of the digestive tract: lymphocytes, plasmocytes, enterochromaffin cells, fibroblasts, myoblasts, nerves cells, vascular or lymphatic endothelium, adipocytes…

Most benign submucosal tumors are discovered as incidental findings. They are most often small, asymptomatic lesions without degenerative potential. However, lesions that are large or ulcerated may cause symptoms.

For their evaluation, many investigation imaging tools are available.

Barium studies are particularly helpful for diagnosing these lesions because the overlying mucosa often appears normal. The rational management of benign and malignant submucosal tumors is critically dependent onendoscopy and on performing deep biopsy specimen. Sometimes definitive treatment can be given through endoscopy for many lesions particularly those that are benign.

A variety of other imaging methods may be helpful in elucidating the nature of a lesion and extent of involvement, including transmural involvement.Endoscopic Ultrasonography associated or not with Fine Needle Aspiration is the logical extension of endoscopy for studying lesions deep beyond mucosa and for determining the precise depth of the lesion that arises in one of the five layers of the digestive wall.CT scan andMRI are particularly helpful for demonstrating extent of the mass and invasion of adjacent structures and reveal metastases.

Conclusion: Assessing these lesions is possible by various imaging modalities and is mandatory in order to characterize their anatomopathologic nature, their benign, potentially malignant or truly malignant character. Proper staging is also important, so that a rational decision can be made about treatment options, such as surveillance, endoscopic or surgical removal, radiation, and chemotherapy.

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Références

  1. APPELMAN H.D. — Mesenchymal tumors of the gastrointestinal tract.In: Ming S.C., Goldman H., eds. Pathology of the gastrointestinal tract. 2nd ed. Baltimore, Md: Williams & Wilkins, 1998, 361–398.

    Google Scholar 

  2. HERRERRA J.L. — Benign and metastatic tumors of the esophagus.Gastroenterol. Clin. North. Am., 1991,20, 775.

    Google Scholar 

  3. HOWARD M. SPIRO. — Clinical Gastroenterology, Fourth Edition 13, Tumors, 219–248.

  4. HABOUCHI N.Y., GEBOES K., SHEPERED N.A., TALBOT I.C. —Gastrointestinal. Polyps, 2002. Greenwich Medical Media, London.

    Google Scholar 

  5. DAVID G.R. — Neoplasms of the stomach.In: Slesinger M.G. (ed): Gastrointestinal Disease, Philadelphia: W.B. Saunders, 1989, 766–767.

    Google Scholar 

  6. GRANBERG D., WILANDER E., STRIDSBERG M., GRANER G., SKOGSEID B., OBERG K. — Clinical symptoms, hormone profiles, treatment and prognosis with gastric carcinoid.Gut, 1998,43, 223–228.

    Article  PubMed  CAS  Google Scholar 

  7. LEVINE M.S. — Benign tumors of the esophagus. Textbook of Gastrointestinal Radiology: Gore and Levine, second edition, chapter 24, 387–433.

  8. LEVINE M.S. — Benign tumors of the stomach and duodenum. Textbook of Gastrointestinal Radiology: Gore and Levine, second edition, chapter 34, 575–600.

  9. COX M.A., COOPER B.T., SAGAR G. — Endoscopy and computed tomography in the diagnosis and follow-up of esophageal leiomyoma.Gut, 1995,37, 288–291.

    Article  PubMed  CAS  Google Scholar 

  10. SCHNALL M.D. — Magnetic resonance imaging of the hollow viscera. Textbook in Gastrointestinal Radiology, second edition, volume 1. Gore. Levine, chapter 8, 86–97.

  11. MADEARL F., HUNTER F., FUSELIER G.et al. — Gastric lipomas: an update of clinical presentation, diagnosis and treatment.Am. J. Gastroenterol., 1984,79, 964–967.

    Google Scholar 

  12. LANZA F.L. — Benign and malignant tumors of the stomach other than carcinoma.In: Haubrich W.S., Schaffner F., Berk J.E., eds.Bokus Gastroenterology, 5th ed. Philadelphia, Pa: Saunders, 1995, 841–858.

    Google Scholar 

  13. LEVINE M.S., MEGIBOW A.J. — Other malignant tumors.In: Gore RM, Levine MS, Laufer I, eds.Textbook of gastro-intestinal radiology, 1st ed. Philadelphia, Pa: Saunders, 1994, 684–716.

    Google Scholar 

  14. POSTLEWAIT R.W. — Benign tumors and cysts of the esophagus.Surg. Clin. North. Am., 1983,63, 925.

    Google Scholar 

  15. MORSON B.C., DAWSON I.M.P. — Nonepithelial tumors.In: gastrointestinal Pathology. Oxford: Blackwell Scientific Publications, 1979, 187–199.

    Google Scholar 

  16. FAIVRE J., BORY R., MOULINIER B. — Benign tumors of the esophagus: value of endoscopy.Endoscopy, 1978,10, 264–268.

    Article  PubMed  CAS  Google Scholar 

  17. PAPAZIAN A., GINESTON J.L., CAPRON J.P., QUENUM C. — Leiomyoblastoma of the stomach: Endoscopic treatment.Endoscopy, 1984, 16, 157–169.

    Article  PubMed  CAS  Google Scholar 

  18. MICHAEL O. — Endoscopic Interpretation: Normal and Pathological Appearances of the gastrointestinal Tract, Blackstone, Raven Press, 1984.

    Google Scholar 

  19. SIVAK M.V. Jr. — Gastroenterologic Endoscopy, W.B. Saunders Company.

  20. DANCIGIER H., LIGHTDALE C.J. — Endosonography in Gastroenterology, Principles, Techniques, Findings, 1999, Thieme.

  21. PALAZZO L., ROSEAU G. — Echo-endoscopie digestive, Masson, 1992.

  22. KANEKO E., KUMAGAI J., HONDA N.et al. — Evaluation of the new giant biopsy forceps in the diagnosis of mucosal and submucosal gastric lesions.Endoscopy, 1983, 15, 322–326.

    Article  PubMed  CAS  Google Scholar 

  23. TIO T.L., TYTGAT G.N.J., Den HARTOG JAGER F.C.A. — Endoscopic ultrasonography for the evaluation of smooth muscle tumours of the upper gastrointestinal tract: an experience with 42 cases.Gastrointest. Endosc., 1990,36, 342–350.

    Article  PubMed  CAS  Google Scholar 

  24. KAJIYAMA T., SAKAI M., TORII A.et al. — Endoscopic aspiration lumpectomy of esophageal leiomyoma derived from themuscularis mucosae.Amer. J. Gastroenterol., 1995,90, 417–422.

    CAS  Google Scholar 

  25. RANCHO D.M., KEMPSON R. — Smooth muscle tumors of the gastrointestinal tract and retroperitoneum. A pathologic analysis of 100 cases.Cancer, 1977, 39, 255.

    Article  Google Scholar 

  26. SONGÜR Y.et al. — EUS diagnosis of lymphomatous polyposis.Gastrointest. Endosc., 2000,52, no 5, 685–687.

    Article  PubMed  Google Scholar 

  27. CAMMAROTA G., CIANCI R., PIROZZI G., GASBARRINI G. — Minimal endoscopic aspects of gastric low-grade MALT lymphoma.Hepato-gastroenterology, 1999,46, 2818–2822.

    PubMed  CAS  Google Scholar 

  28. TAAL B.G., BURGER J.M. — Primary non-Hodgkin's lymphoma of the stomach: Endoscopic diagnosis and the role of surgery.Scand. J. Gastroenterol., suppl. 1991,188, 33–37.

    Article  CAS  Google Scholar 

  29. Al MOFLEH I.A.—Endoscopic features of primary upper gastrointestinal lymphoma.J. Clin. Gastroenterol., 1994,19, 69–73.

    Article  PubMed  Google Scholar 

  30. SWAROOP V.S., MOHANDAS K.M., SWAROOP V.D.et al.—Comparative endoscopic study of primary gastric lymphomavs. gastric carcinoma.J. Surg. Oncol., 1994,56, 94–97.

    Article  PubMed  CAS  Google Scholar 

  31. O'BRIEN D.S., KENNEDY M.J., DALY P.A.et al.—Multiple lymphomatous polyposis of the gastrointestinal tract. A clinicopathologically distinctive form of non-Hodgkin's lymphoma, B-cell centrocytic type.Am. J. Surg. Pathol., 1989,13, 691–699.

    PubMed  Google Scholar 

  32. SEIFERT E., SCHULTE F., WEISMULLER J.et al.—Endoscopic and bioptic diagnosis of malignant non-Hodgkin's lymphoma of the stomach.Endoscopy, 1993,25, 497–501.

    Article  PubMed  CAS  Google Scholar 

  33. KAWAI K.—In:Endoscopic Ultrasonography in Gastroenterology, New York, Igaku-Shoin, 1988.

    Google Scholar 

  34. MOTO Y., OHTA H., SATOMURA Y., WATANABE H., YAMAKAWA O., YAMAGUCHI Y., MOURI I., SAWABU N.—Endoscopic ultrasonography in the diagnosis of extraluminal compressions mimicking gastric submucosal tumors.Endoscopy, 1994,26, 239–242.

    Article  Google Scholar 

  35. BOLONDI I., CASANOVA P., SANTI V.et al.—The sonographic appearance of the normal gastric wall: anin vitro study.Ultrasound Med. Biol., 1986,12, 991–998.

    Article  PubMed  CAS  Google Scholar 

  36. YASUDA K., CHO E., NAKAJIMA M., KAWAI K.—Diagnosis of submucosal lesions of the upper gastrointestinal tract by endoscopic ultrasonography.Gastrointest. Endosc., 1990,37, S17-S20.

    Article  Google Scholar 

  37. BOYCE G.A., SIVAK M.V., RÖSCH T.et al.—Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound.Gastrointest. Endos., 1991,37, 449–454.

    Article  CAS  Google Scholar 

  38. MIETTINEN M., SOKLOMO-RIKALA M., SOBIN L.H., LASOTA J.—Esophageal stromal tumors: a clinicopathologic, immunohistochemical and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas.Am. J. Surg. Pathol., 2000,24, 211–222.

    Article  PubMed  CAS  Google Scholar 

  39. AKIMICHI IMANURAet al.—Glomus Tumor of the Stomach: Endoscopic Ultrasonographic Findings.Am. J. Gastroenter., 1994, vol. 89, no 2, 271–272.

    Google Scholar 

  40. BERTONI G.et al.—Ectopic Sebaceous Glands in the Esophagus: report of Three New Cases and Review of the Literature.Am. J. Gastroenter., 1994, vol. 89, no 10, 1884–1887.

    PubMed  CAS  Google Scholar 

  41. HSU C.C., CHEN J.J., CHANGCHIEN C.S.—Endoscopic features of metastatic tumors in the upper gastrointestinal tract.Endoscopy, 1996,28, 249–253.

    Article  PubMed  CAS  Google Scholar 

  42. ODA I., KONDO H., YAMAO T., SAITO D., ONO H., GOTODA T., YAMAGUCHI H., YOSHIDA S., SHIMODA T.—Metastatic tumors to the stomach: Analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases.Endoscopy, 2001,33 (6), 507–510.

    Article  PubMed  CAS  Google Scholar 

  43. PREVOT S., BIENVENU L., VAILLANT J.C., DE SAINT MAUR P.P. —Benign schwannoma of the digestive tract. A clinicopathological and immunohistochemical study of five cases including a case of esophageal tumor.Am. J. Surg. Pathol., 1999,23, 431–436.

    Article  PubMed  CAS  Google Scholar 

  44. ISAACSON P.G.—Gastrointestinal lymphoma.Hum. Pathol., 1994,25, 1020–1029.

    Article  PubMed  CAS  Google Scholar 

  45. MODLIN I.M., GILLIGAN C.J., LAWTON G.P., TANG L.H., WEST B., DARR U.—Gastric carcinoids. The Yale Experience.Arch. Surg., 1995,130, 250–255.

    PubMed  CAS  Google Scholar 

  46. AASE S., GUNDERSEN R.—Submucous lymphatic cysts of the small intestine.Acta Pathol. Microbiol. Immunol. Scand., 1983,91, 191–194.

    CAS  Google Scholar 

  47. KREUSER E.D.—Primary malignant melanoma of the esophagus.Virch. Arch. (A), 1979,385, 49–59.

    Article  CAS  Google Scholar 

  48. PATEL R.M., DESOTA-LAPAIX F., SIKA J.V.et al.—Granular cell tumor of the esophagus.Am. J. Gastroenterol., 1981,76, 519–523.

    PubMed  CAS  Google Scholar 

  49. HIZAWA K., AOYAGI K., KURAHARA K., SUEKANE H., KUWANO Y., NAKAMURA S.et al.—Gastrointestinal lymphangioma: endosonographic demonstration and endoscopic removal.Gastrointest. Endosc., 1996,43, 620–624.

    PubMed  CAS  Google Scholar 

  50. FENOGLIO-PREISER C., PASCAL R., PERZIN K.—Tumours of intestines. Washington D.C. Armed Forces Institutes of Pathology, 1990.

    Google Scholar 

  51. NAKAMURA S., LIDA M., SUEKANE H.et al.—Endoscopic removal of gastric lipoma: diagnostic value of endoscopic ultrasonography.Am. J. Gastroenterol., 1991,86, 619–621.

    PubMed  CAS  Google Scholar 

  52. Van DAM J., ZUCCARO G. Jr., SIVAK M.V. Jr.—Endosonographic diagnosis of a submucosal gastric cyst.J. Ultrasound Med., 1992,11, 61–63.

    PubMed  Google Scholar 

  53. TANAKA M., AKAHOSHI K., CHIJIIWA Y., SASAKI I., NAWATA J.—Diagnosis value of a submucosal gastric cyst.Am. J. Gastroenterol., 1995,90, 662–663.

    PubMed  CAS  Google Scholar 

  54. INAI M., SAKAI M., KAJIYAMA T., IMADA-SHIRAKATA Y., KIN G., INOUE K., UEDA S., OKUMA M.—Endosonographic characterization of duodenal elevated lesions.Gastrointest. Endosc., 1996,44, 714–719.

    Article  PubMed  CAS  Google Scholar 

  55. LAWRENCE S.P., LARSEN B.R., STACY C.C., McNALLY P.R. —Echoendosonographic and histologic correlation of a fibrovascular polyp of the esophagus.Gastrointest. Endosc., 1994,40, 81–84.

    PubMed  CAS  Google Scholar 

  56. YOSHIKANE H., SUZUKI T., YOSHIOKA N.et al.—Duodenal carcinoid tumor. Endosonographic imaging and endoscopic resection.Amer. J. Gastroenterol., 1995,90, 642–644.

    CAS  Google Scholar 

  57. YAMAMOTO K.—Primary liposarcoma of the stomach resected endoscopically.Endoscopy, 1996,27, 711.

    Article  Google Scholar 

  58. CHANG K.J., YOSHINAKA R., NGUYEN P.—Endoscopic ultrasound-assisted band ligation: a new technique for resection of submucosal tumors.Gastrointest. Endosc., 1996,44, 720–722.

    Article  PubMed  CAS  Google Scholar 

  59. DANCIGIER H., LIGHTDALE C.J.—Endosonography in gastroenterology. Principles, Techniques, Findings, Thieme, Chap. 2.

  60. KOJIMA T., TAKAHASHI H., PARRA-BLANCO A.et al.—Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection.Gastrointest. Endosc., 1999,5, 516–522.

    Article  Google Scholar 

  61. VILMAN P., THORBOLL J.—Endoscopic ultrasound guided fine needle aspiration. A critical appraisal. Update.Gastroenterology, 2001. Tytgat G.N.J., Lundell L., eds John LibbeyEurotext, 2001, 63–75.

  62. WIERSEMA M.J., VILMAN P., GIOVANNINI M., CHANG K.J., WIERSEMA L.M.—Endosonography guided fine needle aspiration biopsy: Diagnostic accuracy and complication assessment.Gastroenterology, 1997,112, 1087–1095.

    Article  PubMed  CAS  Google Scholar 

  63. ROSAI J.—Stromal tumours.In: Ackermans Surgical Pathology, Rosai J. (ed.) St Louis, Boston, Mosby, 1995, pp. 645–647.

    Google Scholar 

  64. BINMOELLER K.F., GRIMM H., SOHENDRA N.—Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma.Gastrointest. Endosc., 1993, 39, 172–174.

    Article  PubMed  CAS  Google Scholar 

  65. FUJISAKI J., MINE T., AKIMOTO K.et al.—Enucleation of a gastric leiomyoma by combined laser and snare electrocuting technique.Gastrointest. Endosc., 1988,34, 128–130.

    Article  PubMed  CAS  Google Scholar 

  66. SONGÜR Y., OKAÏ T, WATANABE H., MOTOO Y., SAWABU N.—Endosonographic evaluation of giant gastric folds.Gastrointest. Endosc., 1995,41, 468–474.

    Article  PubMed  Google Scholar 

  67. ARISA-NASR J., JIMENEZ A., KEIRNS C.et al.—The role of endoscopic biopsy in the diagnosis of gastric lymphoma: A morphologic and immunohistochemical reappraisal.Hum. Pathol., 1991,22, 339–348.

    Article  Google Scholar 

  68. SUEKANE H., IIDA M., KUWANO Y.et al.—Diagnosis of primary early gastric lymphoma. Usefulness of endoscopic mucosal resection for histological evaluation.Cancer, 1993,71, 1207–1213.

    Article  PubMed  CAS  Google Scholar 

  69. PALAZZO L., ROSEAU G., RUSKONE-FOURMESTRAUX A.et al.—Endoscopic ultrasonography in the local staging of primary gastric lymphoma.Endoscopy, 1993,25, 502–508.

    Article  PubMed  CAS  Google Scholar 

  70. BOLONDI L., CASANOVA P., CALETTI G.C.et al.—Primary gastric lymphoma versus gastric carcinoma: Endoscopic US evaluation.Radiology, 1987,165, 821–826.

    PubMed  CAS  Google Scholar 

  71. CALETTI G.C., LOREANA Z., BOLONDI L.et al.— Impact of endoscopic ultrasonography on diagnosis and treatment of primary gastric lymphoma.Surgery, 1988,103, 315–320.

    PubMed  CAS  Google Scholar 

  72. TIO T.L., Den HARTOG JAGER F.C., TYTGAT G.N.— Endoscopic ultrasonography of non-Hodgkin lymphoma of the stomach.Gastroenterology, 1986,91, 401–408.

    PubMed  CAS  Google Scholar 

  73. SUEKANE H., IIDA M., YAO T.et al.—Endoscopic ultrasonography in primary gastric lymphoma: Correlation with endoscopic and histological findings.Gastrointest. Endosc., 1993,39, 139–145.

    Article  PubMed  CAS  Google Scholar 

  74. LEVY M., HAMMEL P., LAMARQUE D., MARTY O., CHAUNETTE M.T., HAIOUN C.et al.—Endoscopic ultrasonography for the initial staging and follow-up in patients with low-grade gastric lymphoma of mucosa-associated lymphoid tissue treated medically.Gastrointest. Endosc., 1997,46, 328–333.

    Article  PubMed  CAS  Google Scholar 

  75. NAKAMURA S., MATSUMOTO T., SUEKANE H.et al. —Predictive value of endoscopic ultrasonography for regression of gastric low grade and high grade MALT lymphomas after eradication ofHelicobacter pylori.Gut, 2001,48, 454–460.

    Article  PubMed  CAS  Google Scholar 

  76. FUJISHIMA H., MISAWA T, MARUOKA A., CHIJIIWA Y., SAKAI K., NAWATA H.—Staging and follow-up of primary gastric lymphoma by endoscopic ultrasonography.Am. J. Gastroenterol., 1991,86, 719–724.

    PubMed  CAS  Google Scholar 

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  1. Département de Gastroentérologie, University de Liège, (Belgique)

    V. Gillard

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Pour le Club Belge d'Echoendoscopie DigestiveFor the Belgian Group of Digestive Endosonography

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Gillard, V. Evaluation par imagerie médicale des Tumeurs Non Epithéliales du tube digestif. Acta Endosc 33, 291–312 (2003). https://doi.org/10.1007/BF03015744

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