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Gastrointestinal Pathology - Case 5 - Part comprehensive
   

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PET TUMOR IMAGE 12-08-04

HISTORY: GI stromal tumor, Gleevec chemotherapy.

RADIOPHARMACEUTICAL: 10.2 mCi F-18-FDG

PROCEDURE: One hour after the intravenous administration of F-18-FDG, whole body images were obtained.

FINDINGS: Comparison study dated 14 Apr. 2004 .

There are at least four small-to-large sized areas of intense activity within the abdomen and pelvis in the expected location of bowel: one in the mid ascending colon, one in the anterior midline pelvis at the level of the sacrum, one at the same level but in the right posterolateral aspect of the pelvis, and one large area just above and to the right of the dome of the bladder in the region of the sigmoid colon.

There is focal faint, abnormal activity within the posterolateral aspect of the right lobe of the liver (segment 7), or the right posterior sulcus; with a small, faint area of focal activity in the posteromedial aspect of the left lung near the very inferior portion of the left pulmonary hilum.

There is normal activity within the brain, salivary glands, oropharynx, the distal esophagus, the kidneys, ureters, and the bladder.

In comparison with the previous examination, the faint areas in the liver and left lung are new; and the bowel pattern has changed somewhat, with a large new area in the colon to the right and just above the bladder, increasing activity in the midline and the right posterolateral pelvis, and persistent stable activity in the ascending colon.

IMPRESSION:

SMALL, FAINT AREAS OF ACTIVITY SUSPICIOUS FOR (BUT NOT DEFINITIVE OF) DEVELOPING METASTASES IN THE LIVER AND THE POSTEROMEDIAL ASPECT OF THE LEFT LUNG NEAR THE INFERIOR PORTION OF THE PULMONARY HILUM.

SEVERAL AREAS OF ABNORMAL ACTIVITY WITHIN THE BOWEL, WHICH MAY REPRESENT METASTASES, OR OTHER LESION SUCH AS ADENOMAS, POLYPS, ETC. A COLONOSCOPY WOULD BE VERY HELPFUL IN FURTHER EVALUATION.

CT of abdomen with new lesions in liver June 2004
CT of abdomen with new lesions in liver
CT of abdomen with new lesions in liver
CT of abdomen with new lesions in liver

ABD CT W/CONT 6-23-04

History: GI stromal tumor

Technique: 6.5 mm axial images were obtained through the abdomen with IV and oral contrast.

Findings: Comparison made with study performed April 7, 2004 .

Limited evaluation of the lung bases demonstrates no abnormalities. The previously noted without a pleural effusion resolved.

The largest hypodense lesion within the liver, within the lateral segment of the left lobe measures 9 mm in diameter, not significantly changed the prior exam. Multiple new hypodense lesions are now seen, predominantly within the posterior segment of the right lobe. The gallbladder appears normal. There is the prior splenectomy. A gastrectomy has been performed. Pancreas appears normal. There continues to be a small amount of fluid seen within the abdominal cavity, although it has decreased compared to the previous examination. No abnormally enlarged lymph nodes are present. Osseous structures appear normal.

IMPRESSION:

1. Interval increase in number of hypodense liver lesions, concerning for metastatic disease. The dominant hypodense lesion is unchanged in size as described above.

2. Status post splenectomy and gastrectomy.

3. Interval resolution of right-sided pleural effusion, and decreased ascites.

 

01/15/2004 ABD MRI W/WO

HISTORY: GI stromal tumor, new liver lesion.

FINDINGS: Comparison with CT scan of the abdomen dated 6 January 2004 .

TECHNIQUE: Axial T1 SPGR in and out of phase axial T2 FSE with normal and long TE Axial FAME dynamic gadolinium serious Axial FAME delayed post gadolinium. The lesions located in the lateral segment of the left lobe of the liver, cephalad aspect of the anterior segment of the right lobe of the liver, and inferior aspect of the anterior segment of the right lobe of the liver are again visualized and demonstrate similar size as seen on CT scan. No other areas of abnormal hepatic attenuation are seen. The gallbladder demonstrates normal configuration. There is no evidence of intrahepatic or extrahepatic biliary dilation. The spleen is absent. The kidneys, pancreas, and adrenal glands demonstrate normal configuration and signal intensity. There is normal cortical medullary differentiation of the kidneys bilaterally. There is no evidence of pancreatic ductal dilation. There is no definite evidence of pathologic size range lymphadenopathy seen involving the included portions of the retrocrural, retroperitoneal, or mesenteric lymph node chains. No other definite evidence of abnormal soft tissue mass or fluid collection is seen within the abdomen. The other adequately visualized soft tissues and osseous structures demonstrate no definite abnormalities. Following the administration of gadolinium chelate contrast material, there is heterogeneous peripheral enhancement of all three hepatic lesions. No other areas of abnormal enhancement are seen. The hepatic and portal veins appear patent. The kidneys demonstrate normal excretion of contrast bilaterally.

IMPRESSION:HEPATIC ENHANCING MASSES HAVE CHARACTERISTICS CONSISTENT WITH METASTATIC FOCI IN THIS PATIENT WITH HISTORY OF GI STROMAL TUMOR AND NEW HEPATIC LESIONS. THE PREVIOUSLY NOTED STABLE MASS DOES DEMONSTRATE ENHANCEMENT AND MAY REPRESENT A METASTATIC FOCUS WITH A RELATIVELY INDOLENT BEHAVIOR. THIS DOES NOT HAVE TYPICAL IMAGING CHARACTERISTICS OF A HEMANGIOMA. POSTSPLENECTOMY CHANGES AS NOTED. NO OTHER DEFINITE EVIDENCE OF ABNORMAL CONFIGURATION OR ATTENUATION TO SUGGEST PATHOLOGIC LYMPHADENOPATHY OR ADDITIONAL METASTATIC FOCI.

 

01/06/2004 ABD CT W/CONT

HISTORY: GI stromal tumor.

TECHNIQUE: 6.5 mm collimated axial CT images were acquired from the domes the diaphragms through the iliac crests, following the administration of intravenous and oral contrast. No immediate contrast reactions occurred.

FINDINGS: Comparison 9/16/03 . Limited evaluation of the lung bases shows no effusion or pulmonary mass lesion. Within the anterior segment right hepatic lobe on image number 12 there is a 5 mm hypodensity which is stable compared to the prior study. A new area of hypodensity has developed in the lateral segment left hepatic lobe measuring 2.7 x 1.2 cm. A 5 mm hypodensity has developed in the inferior right hepatic lobe measuring 5 mm on image 23. There are postoperative changes of splenectomy and gastrectomy. The kidneys are normal. The adrenals and pancreas are normal. There postoperative changes near the gastroesophageal junction with surgical clips noted at this site. Surgical clips are also seen in the right upper quadrant. The intra-abdominal bowel is unremarkable appearance. The vascular structures are unremarkable. No osseous destructive lesions are seen.

IMPRESSION: INTERVAL DEVELOPMENT OF TWO NEW HEPATIC HYPODENSITIES, THE LARGEST IS SEEN IN THE LATERAL SEGMENT LEFT HEPATIC LOBE MEASURING 2.7 X 1.2 CM, WITH THE SMALLER IN THE INFERIOR RIGHT HEPATIC LOBE MEASURING 5 MM. STABLE APPEARANCE OF HYPODENSITY IN THE ANTERIOR SEGMENT RIGHT HEPATIC LOBE, MEASURING 5 MM. POSTOPERATIVE CHANGES AS DESCRIBED ABOVE.

 

09/16/2003 ABD CT W/WO CON

History: Cystic neoplasm of the pancreas.

Technique: 6.5 mm thick slices at 5 mm intervals prior to administration of intravenous contrast. 3.2 mm thick slices at 2 mm intervals during the pancreatic phase. 5 mm thick axial contiguous images during the portal venous phase. Oral contrast.

Findings: The lung bases are clear. The bones are normal. There is a 4 mm low attenuation lesion between the medial segment of the left lobe of the liver and the anterior segment of the right lobe of the liver. This lesion is too small to characterize. The gallbladder is normal. The patient has had a splenectomy. There is a surgical anastomosis at the gastric cardia. The patient has had a Billroth II. The pancreas appears normal. The adrenal glands are normal. The kidneys appear normal. There are small paraaortic lymph nodes.

Impression: Billroth II surgery. No evidence of cystic pancreatic neoplasm. Small hepatic hypodensity of uncertain significance. There is a chance, though small, that MRI may be able to characterize this lesion. Alternatively, a follow-up examination in six months to exclude interval growth is recommended.

07/17/2003 CHEST XRAY 1V

History: Pancreas neoplasm. Consider effusion/pneumonia.

Findings: Single portable view of the chest with comparison to PA and lateral views from 7/10/2003 demonstrates new hazy opacification of the left lung base obscuring the diaphragm and costophrenic angle. This likely represents atelectasis and pleural effusion although pneumonia cannot be excluded. The remaining left lung and right lung parenchyma are normal. Taking into consideration differences in technique, the cardiomediastinal contours are unchanged. No new osseous abnormalities. Staples are seen projecting over the middle of the abdomen included on the film. A left upper quadrant drain is also noted.

IMPRESSION: Postoperative development of left-sided pleural
effusion/atelectasis. Pneumonia cannot be excluded.

07/10/2003 CHEST XRAY 2V

PROCEDURE : POSTERIOR-ANTERIOR AND LATERAL PROJECTIONS

HISTORY : Cystic pancreatic lesion

COMPARISON : None

FINDINGS: No parenchymal or pleural space process is evident. Cardiac and mediastinal contours are normal. The pulmonary vessels are normal in caliber.

IMPRESSION: No parenchymal process is present.