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Bloodborne Metastatic Tumors to the Gastrointestinal Tract: CT Findings with Clinicopathologic Correlation

So Yeon Kim1, Kyoung Won Kim1, Ah Young Kim1, Hyun Kwon Ha1, Jung-Sun Kim2, Seong Ho Park1, Jeong Kon Kim1, Mi-Jung Kim2, Sung Won Park1 and Moon-Gyu Lee1

1 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2 dong, Songpa-ku, Seoul, South Korea 138-736.
2 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.


Figure 1
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  		Fig. 1A —44-year-old woman with metastatic malignant melanoma to stomach. Contrast-enhanced CT scan shows diffuse wall thickening and strong contrast enhancement (arrowheads) along gastric body. Hepatic metastases are also seen (asterisk).

 

Figure 2
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  		Fig. 1B —44-year-old woman with metastatic malignant melanoma to stomach. Photograph from gastrofiberscope shows small elevated lesions with brown-to-black pigmentation. Linear fissures (arrowheads) radiating distinctly to central ulceration are noted over surface, producing spoked wheel pattern.

 

Figure 3
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  		Fig. 1C —44-year-old woman with metastatic malignant melanoma to stomach. Immunohistochemical study for HMB 45 shows positive staining of tumor cells (arrowheads), supporting diagnosis of malignant melanoma.

 

Figure 4
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  		Fig. 2A —58-year-old man with metastatic malignant melanoma to duodenum. Radiograph from upper gastrointestinal barium examination shows multiple submucosal masses in second and third part of duodenum, one of which has target or bull's-eye appearance (arrowheads) produced by ulceration.

 

Figure 5
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  		Fig. 2B —58-year-old man with metastatic malignant melanoma to duodenum. Unenhanced CT scan with oral contrast administration reveals multiple intraluminal polypoid masses (arrowheads).

 

Figure 6
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  		Fig. 3A —51-year-old man with metastatic malignant melanoma to jejunum. Contrast-enhanced CT scan shows intussusception (curved arrow).

 

Figure 7
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  		Fig. 3B —51-year-old man with metastatic malignant melanoma to jejunum. Large intraluminal fungating mass (arrows) is seen in distal end of intussusceptum, presumed as leading point of intussusception.

 

Figure 8
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  		Fig. 3C —51-year-old man with metastatic malignant melanoma to jejunum. Metastatic peritoneal seeding nodules are also observed (arrowheads) at CT, displaying poor contrast enhancement.

 

Figure 9
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  		Fig. 3D —51-year-old man with metastatic malignant melanoma to jejunum. Photograph of gross specimen also shows large intraluminal fungating mass as leading point (arrows). Multiple small tumor implants with dark brown-to-black pigmentation (arrowheads) are scattered in jejunum, suggesting periodic embolic shower as pathogenesis. Scale: cm.

 

Figure 10
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  		Fig. 4A —69-year-old woman with metastatic malignant melanoma to ileum. Contrast-enhanced CT scan shows large cavitary mass (arrows) with low-grade enhancement in ileum. Mild perienteric infiltration is also seen (arrowheads).

 

Figure 11
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  		Fig. 4B —69-year-old woman with metastatic malignant melanoma to ileum. Photograph of gross specimen shows large fungating mass with irregular ulcerated surface (arrows) in ileum. Scale: cm.

 

Figure 12
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  		Fig. 5A —78-year-old man with metastatic small cell carcinoma of lung to ileum. Contrast-enhanced CT scan shows intraluminal fungating mass (arrow) in ileum with large surface ulceration (arrowhead). Adjacent, conglomerate mesenteric masses encasing mesenteric vessels are also seen (curved arrow).

 

Figure 13
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  		Fig. 5B —78-year-old man with metastatic small cell carcinoma of lung to ileum. Photograph of gross specimen reveals intraluminal ulcerated fungating tumor (arrows) and mesenteric mass (curved arrow). Scale: cm.

 

Figure 14
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  		Fig. 5C —78-year-old man with metastatic small cell carcinoma of lung to ileum. Photograph of cut surface shows communication of intraluminal mass (arrowheads) and mesenteric mass (curved arrow) through large ulcer crater on surface (asterisk). Scale: cm.

 

Figure 15
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  		Fig. 5D —78-year-old man with metastatic small cell carcinoma of lung to ileum. High-power photomicrograph shows small round cells with similar features as primary lung cancer (H and E, x200).

 

Figure 16
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  		Fig. 5E —78-year-old man with metastatic small cell carcinoma of lung to ileum. Immunohistochemical staining for synaptophysin shows positive staining, supporting diagnosis of small cell carcinoma.

 

Figure 17
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  		Fig. 6A —56-year-old man with metastatic poorly differentiated non-small cell carcinoma of lung to jejunum. Contrast-enhanced CT scan shows luminal encircling mass with poor contrast enhancement (arrow) in jejunum.

 

Figure 18
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  		Fig. 6B —56-year-old man with metastatic poorly differentiated non-small cell carcinoma of lung to jejunum. Another jejunal mass is noted (arrow), and small mesenteric nodules (curved arrow) are adjacent to thickened bowel loop. Extraluminal air bubbles (arrowhead) and perienteric infiltration are present, suggestive of bowel perforation.

 

Figure 19
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  		Fig. 6C —56-year-old man with metastatic poorly differentiated non-small cell carcinoma of lung to jejunum. Photograph of gross specimen reveals multiple ulcerative masses (arrows) in jejunum. Scale: cm.

 

Figure 20
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  		Fig. 6D —56-year-old man with metastatic poorly differentiated non-small cell carcinoma of lung to jejunum. Photograph of cut surface of specimen shows grossly submucosal location of tumor and focal disruption of muscle and serosa (arrowheads). Scale: cm.

 

Figure 21
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  		Fig. 6E —56-year-old man with metastatic poorly differentiated non-small cell carcinoma of lung to jejunum. Low-power photomicrograph shows tumor cells (asterisk) are mainly confined to serosa, muscularis propria (MP), and submucosa (SM), in contrast with intact mucosa (m). These findings suggest possible mechanism of disease spread is secondary invasion of small bowel that may have occurred from metastatic deposits in mesentery (H and E, x20).

 

Figure 22
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  		Fig. 7A —66-year-old woman with metastatic lobular carcinoma of breast to stomach. Radiograph from upper gastrointestinal examination shows diffuse wall thickening and rigidity of lower body of stomach (arrows) representing typical linitis plastica pattern.

 

Figure 23
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  		Fig. 7B —66-year-old woman with metastatic lobular carcinoma of breast to stomach. Contrast-enhanced CT scan shows diffuse mural thickening along body of stomach (arrowheads).

 

Figure 24
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  		Fig. 7C —66-year-old woman with metastatic lobular carcinoma of breast to stomach. Photograph from gastrofiberscope shows diffuse fold thickening in gastric body.

 

Figure 25
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  		Fig. 7D —66-year-old woman with metastatic lobular carcinoma of breast to stomach. High-power photomicrograph reveals cords of infiltrating neoplastic cells arranged in single-file formation (ellipse), which is identical to primary lobular carcinoma of breast (H and E, x100).

 

Figure 26
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  		Fig. 8 —64-year-old woman with metastatic renal cell carcinoma (RCC) to duodenum. Contrast-enhanced CT scan shows intraluminal fungating mass with strong enhancement (arrows) in third portion of duodenum. Patient had history of right nephrectomy for RCC.

 

Figure 27
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  		Fig. 9A —51-year-old woman with metastatic choriocarcinoma to jejunum. Radiograph from small-bowel follow-up examination shows multiple nodular filling defects in jejunum (arrows).

 

Figure 28
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  		Fig. 9B —51-year-old woman with metastatic choriocarcinoma to jejunum. Contrast-enhanced CT scan shows large mass in jejunum, appearing as cavitary lesion (arrowheads).

 

Figure 29
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  		Fig. 9C —51-year-old woman with metastatic choriocarcinoma to jejunum. Low-power photomicrograph shows tumor with hemorrhagic necrosis is mainly confined to proper muscle and submucosa and is only focally extended to mucosa (curved arrow) (H and E, x40).

 

Figure 30
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  		Fig. 9D —51-year-old woman with metastatic choriocarcinoma to jejunum. High-power photomicrograph shows tumor consists of two different types of cells, cytotrophoblast (arrowheads) and syncytiotrophoblast (arrows), supporting diagnosis of choriocarcinoma (H and E, x100).

 

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